LIBRARY OF CONGRESS, 



d^Hp. - dnpongfjt fa 

Shelf _j£9£fi 

UNITED STATES OF AMERICA. 



V 



A HANDBOOK 



OF 



Obstetrical Nursing, 



FOR 



NURSES, STUDENTS AND MOTHERS. 



COMPRISING THE COURSE OF INSTRUCTION IN OBSTETRICAL 

NURSING GIVEN TO THE PUPILS OF THE TRAINING 

SCHOOL FOR NURSES CONNECTED WITH THE 

WOMAN'S HOSPITAL OF PHILADELPHIA. 



BY 



1° 



4- 

ANNA M. FULLERTON, M. D., 

DEMONSTRATOR OF OBSTETRICS IN THE WOMAN'S MEDICAL COLLEGE OF 
PENNSYLVANIA ; PHYSICIAN-IN-CHARGE AND OBSTETRICIAN AND GYNE- 
COLOGIST TO THE WOMAN'S HOSPITAL OF PHILADELPHIA, AND 
SUPERINTENDENT OF THE NURSE TRAINING SCHOOL OF 
THE WOMAN'S HOSPITAL OF PHILADELPHIA. 



PHILADELPHIA : 

BLAKISTON, SON & CO., 

I OI 2 WALNUT STREET. 
1890 



" c oPYRlGH7 V 

DEC 181889 






Copyright, 1889, by Anna M. Fullerton. 



PRESS OF WM. F. FEU. & CO. 

1220-24 SANSOM STREET, 

PHILADELPHIA. 






TO 



Dr. ANNA E. BROOMALL, 

PROFESSOR OF OBSTETRICS IN THE WOMAN'S MEDICAL COLLEGE 
OF PENNSYLVANIA, 

ATTENDING OBSTETRICIAN AND GYNAECOLOGIST, 

AND FORMER PHYSICIAN-IN-CHARGE, 

OF THE 

WOMAN'S HOSPITAL OF PHILADELPHIA, 

THIS VOLUME 
IS AFFECTIONATELY DEDICATED. 



PREFACE 



The teachings embodied in this little book are 
chiefly the substance of a series of lectures deliv- 
ered, yearly, by Dr. Anna E. Broomall to the nurse- 
pupils of the Woman's Hospital of Philadelphia. 

The methods advocated by Dr. Broomall are 
strictly observed in the practical work of the 
Maternity connected with the Woman's Hospital 
— a building mainly planned by Dr. Broomall and 
built during her administration as Physician-in- 
Charge of the Woman's Hospital.. 

The excellent results attained by an adherence 
to these methods prove the value of cleanliness, 
antisepsis and eternal vigilance on the part of the 
nurse, in averting the dangers of childbirth and 
reducing the mortality of early infancy. 

The great importance of a thorough understand- 
ing of the many little details of scientific nursing 
on the part of the physician leads me to trust that 
this little book may be of value to physician as 

v 



VI PREFACE. 

well as nurse ; and since both of these must have 
the entire support, sympathy and assistance of the 
patient in their efforts for her well-being, the direc- 
tions herein given as to preparations to be made, 
and rules of action to be observed, will, it is hoped, 
enable the patient to work in harmony with those 
who are working for her good. 

My thanks are due to Dr. Broomall for her 
kindly advice and encouragement in the comple- 
tion of this handbook, and to Dr. Louise L. Wylie 
for valuable assistance given in the preparation of 
the illustrations. 

ANNA M. FULLERTON. 

Woman's Hospital of Philadelphia, 
December, 1889. 



CONTENTS 



CHAPTER I. PAGE 

Signs of Pregnancy 17 

CHAPTER II. 
Management of Pregnancy, 22 

CHAPTER III. 
Accidents of Pregnancy, 41 

CHAPTER IV. 
Preparations for the Labor, 47 

CHAPTER V. 

Signs of Approaching Labor and the Process of 
Labor, $9 

CHAPTER VI. 
Duties of the Nurse during Labor, 65 

CHAPTER VII. 
Accidents and Emergencies of Labor, 83 

CHAPTER VIII. 

Care of the New-born Infant, 101 

vii 



Vlll CONTENTS. 

CHAPTER IX. PAGE 

Management of the Lying-in 130 

CHAPTER X. 

Characteristics of Infancy in Health and Dis- 
ease, , 170 

CHAPTER XI. 
The Ailments of Early Infancy, . . 178 

Index, 209 



LIST OF ILLUSTRATIONS, 



FIG. PAGE 

1. Abdominal Belt, 25 

2. Spiral Reverse Bandage of Lower Extremity, 29 

3. Nipple Protector, 33 

4. Chemilette, 34 

5. Divided Skirt, 34 

6. Union Undergarment, 35 

7. Leglette, 35 

8. Equipoise Waist, 38 

9. Garrigues' Occlusion Dressing, 49 

10. Nightingale Wrap, 51 

11. Sylvester Method of Artificial Respiration 1st movement, . 87 

12. " " " " " 2d " . 88 

13. Schultze's " " u " 1st " . 90 

14. " " ." k ' " 2d " . 91 

15. Position of Patient in Hemorrhage After Labor, 97 

16. Home-made Bath Tub and Crib, no 

17. Lactometer, 116 

18. Sterilizer (Starr's), 123 

19. Feeding-bottle (graduated), Starr, 126 

20. Rubber Nipple, 128 

21. Nipple Shield, 143 

22. Variously Shaped Nipples, 145 

23. Figure-of-8 of one Breast, 146 

24. Figure-of-8 of both Breasts, 147 

25. Garrigues' Breast Bandage, 148 

26. Breast Pump, 149 

27. Handkerchief Bandage of Breast, 150 

28. DouWe Y Bandage of Breast, 152 

29. Obstetrical Breast Support, 153 

30. Tarnier's Couveuse, 180 

31. Auvard's " (interior), 184 

32. " " (exterior), 185 

33. Swaddled Baby, 186 

34. Single-bulb Syringe, 194 

ix 



" He shall gather the lambs with his arm and carry them in His 
bosom, and shall gently lead those that are with young." n 

— Isaiah, Chap, xl, v. u. 



OBSTETRICAL NURSING. 



CHAPTER I. 

SIGNS OF PREGNANCY. 
The signs of pregnancy may be divided into signs of 

11 1 •• i 111 11 pregnancy, 

three classes : the suspicious, the probable, and the 
certain. 

Under the head of suspicious signs may be classed Suspicious 

° signs. 

the many nervous sensations which are apt to ac- 
company early pregnancy ; as, general discomfort, 
sudden changes of temperature, headache, tooth- 
ache, giddiness, faintness, changes in disposition. 

Of the probable signs, one of the earliest andP robable 

r fe ' signs. 

most constant is the stoppage of the monthly flow Cessation of 

1 L ° J menstru- 

in a person who has been regular. This may be, ation - 
however, caused by other conditions than preg- 
nancy. Thus, change in one's mode of living, a 
new climate, or general ill-health may produce the 
same result. In the early months of marriage we 
may also have an irregularity in menstruation 
where there is no pregnancy. On the other hand, 
2 iy 



I 8 OBSTETRICAL NURSING. 

in rare instances, we may have the monthly flow 
persisting for some months or throughout the entire 
pregnancy. It is then generally scanty and short 
in duration. 
S!o?of ed A deepening in the color of the vagina and vulva, 
vagina. ^y which they take on a purplish hue, is another 
sign, and is caused by the enlargement of the blood 
vessels and a stoppage of the circulation, due to 
pressure from the enlargement of the uterus. This 
coloration may be caused to some extent by tumors. 
Develop- Increase in the size of the breasts occurs in the 
breasts. early months of pregnancy with a deposit of color- 
ing matter in the areola, or ring, which surrounds 
the nipple. Some of this coloring matter seems 
to extend irregularly over the outer margin of 
the ring, and is called the " secondary areola " or 
" areola of Montgomery.'' With this distention 
of the breasts there is also a secretion found in 
them — a watery fluid, sometimes yellowish in 
color, known as " colostrum." 

Temporary distention of the breasts, with the 
accumulation of this secretion, may occur in a 
slighter degree as an accompaniment of menstrua- 
tion, or it may persist for a long time after a woman 
has stopped nursing her infant. 
Enlarge- Enlargement of the abdomen, which begins about 
abdomen, the third month of pregnancy, is another important 
sign. Yet this may also be caused by tumors, or 



SIGNS OF PREGNANCY. 1 9 

by flatulence, or the deposit of fat in the abdominal 
walls. 

Marks upon the abdomen, due to the rapid " stria." 
stretching of the skin, sometimes occur in great 
numbers, and are called " striae," owing to the fact 
of their resemblance to the marks left by whip- 
lashes. These marks sometimes extend down 
upon the thighs. This, too, may be caused by 
tumors. The " brown line " of pregnancy is the Brown-iine 
deposit of pigment in the median line of the ab-ofp"^! sk " 
domen. This may exist when there is no preg- m 
nancy, as also may the peculiar browning of 
the skin found in irregular patches over the face, 
particularly on the forehead, and called the " mask 
of pregnancy." 

" Morning sickness," another sign, begins early in Morning 

sickness. 

the second month or at the time of the first missed 
period. It is generally confined to the first three 
months and is largely a nervous symptom. It 
varies much, however, in degree and time of occur- 
rence. Sometimes it is simply a slight feeling of 
sickness at the stomach occurring early in the morn- 
ing; again, it may persist throughout the entire day, 
or it may occur one day and not again for several 
days. Sometimes it continues throughout the 
entire pregnancy, and is then dangerous because of 
the constant loss of food. Sometimes it occurs 
early in the pregnancy, then disappears to reappear 



ing 



20 OBSTETRICAL NURSING. 

in the last month, when there is direct pressure 
upon the stomach. 
Quicken- " Quickening" — or the appreciation of the move- 
ments of the child by the mother — is another prob- 
able sign, and is first experienced about the middle 
of pregnancy. A woman who has previously borne 
children feels this sensation about two weeks earlier 
than one pregnant for the first time. 
abi^signs 13 " There are other probable signs of pregnancy 
which would come only under the observation of 
the physician. As they require considerable knowl- 
edge of obstetrics and skill in the conducting of an 
examination for the discovery of pregnancy, we 
will not do more than refer to them here. 
Positive The positive signs of pregnancy as agreed upon 

by most obstetricians are but two : the direct 
appreciation of the parts of the child by touch, and 
the " foetal pulse," or heart sounds, of the child. 
The " foetal pulse" is, as a rule, twice as fast as the 
pulse of the mother. It is hardly strong enough to be 
heard, even by experienced ears, much before the 
5 th month — or end of the 20th week — rarely heard 
well before the 24th week. 
Methods of The ordinary method of reckoning the probable 
termination date of confinement is as follows : Learn on what 
nancy g day the last monthly flow began, then count three 
months backward (or nine months forward) and 
add seven days. For example, say that a woman 



SIGNS OF PREGNANCY. 21 

was unwell last on March 15th, counting three 
months back, gives December 15th; add seven 
days, and we have December 22d as the probable 
date of her confinement. When, for any reason, 
it is impossible to make the calculation by this 
method, it may be computed by adding four and a 
half months to the date of quickening in the case 
of a woman pregnant for the first time, and five 
months in the case of one who has previously 
borne children. 

The third method, that of adding forty weeks, or 
ten lunar months, to the date of conception is too 
uncertain to be of much practical use. Examina- 
tion of the patient by an intelligent physician who 
knows and appreciates the distinctive signs of the 
several months offers a fourth method of comput- 
ing the date of pregnancy. 



tion 



CHAPTER II. 

MANAGEMENT OF PREGNANCY. 

Attention to The management of pregnancy consists, for the 
health. most part, in greater attention to the laws of health. 
The increased activity of all the organs of the body, 
together with the disturbances caused by pressure, 
necessitates this. 
constipa- Constipation is an almost invariable accompani- 
ment of pregnancy. In the early months it is a 
sympathetic condition ; later, the effect of direct 
pressure upon the bowels. It is also, undoubtedly, 
in part due to the want of exercise. 

The treatment of constipation is the same as in 
other conditions, except that only mild laxatives are 
used. Regularity in attention to the bowels, a glass 
of cold water at night and again in the morning, 
liquids (either milk or water), not taken with the 
meals, but in the intervals, a teaspoonful of common 
salt in the water occasionally, the use of uncooked 
fruit and coarse bread, the avoidance of starches and 
fine flour — all these are helpful in overcoming this 
condition. There is an objection to the use of 
sugared fruits, as confections of fruit, senna leaves, 
etc., because of their liability to disturb the stomach. 

22 



MANAGEMENT OF PREGNANCY. 23 

Prunes are, perhaps, the least objectionable; licor- 
ice powder, because of the senna which. it contains, 
is apt to cause griping pains. Rhubarb is, perhaps, 
the best of the mild laxatives. A small piece of 
rhubarb root, the size of a pea, may be taken at 
night, followed by a glass of water. If there is an 
objection to its taste, it may be taken in pill form. 

Cream of tartar, a half a teaspoonful being taken 
at night in a cup of cold water, is often efficient. 
In some cases it may be necessary to repeat the 
dose in the morning. 

Massage of the abdomen, so efficient in the man- 
agement of constipation, should never be resorted 
to in the pregnant state, as it is apt to excite uterine 
contractions, and may lead to a miscarriage. There 
is an objection to the too frequent use of enemata on 
the same ground; also, the habit is thus acquired of 
depending upon this stimulus, and over-distention 
of the bowel is the result. It may be necessary, 
however, occasionally to alternate an enema with a 
laxative, especially when the patient suffers from 
piles. 

Diarrhoea is rather a rare disturbance of preg- Diarrhoea, 
nancy, but it sometimes occurs as a direct result 
of constipation — small, hardened masses forming in # 
the bowel, known as " scybala," which produce an 
irritation of the mucous lining. The use of rhubarb 
night and morning, in the manner described above, 



24 OBSTETRICAL NURSING. 

until all the masses are removed from the bowels, 
will serve tp check the diarrhoea. 

The urinary Changes in the urinary organs are mainly due to 
direct pressure. In the first three months of preg- 
nancy there is direct pressure on the bladder, hence 

of r th a e tility g rea t irritation, due to interference with the disten- 

biadder. |.j on Q f fae bladder, producing a constant desire to 
pass water. For this the recumbent position is the 
only help. The uterus rises in the abdomen at the 
end of the third month, and the bladder being thus 
relieved from pressure, this symptom passes away. 

Retentionof The tendency from the fourth to the ninth month 
is to the accumulation of urine, because there is 
less than the proper irritability of the bladder, the 
organ being flattened between the uterus and the 
abdominal wall, and its walls thereby suffering a 
partial paralysis. 

Inco ^f In the last month there is incontinence of urine, 

nence 01 ' 

urme. because the pressure is so great that there is no 

room for the accumulation of urine. 
Retentionof During labor there is pressure upon the neck of 
monthof as the bladder and urethra, leading to retention. This 
may exist for the last two weeks of pregnancy. 
Necessity for the use of the catheter is confined, as 
a rule, to this period. The distention of the blad- 
der may impede labor. With the drawing up of 
the uterus the bladder is drawn up and the urethra 
elongated, hence the use of the long rubber catheter, 



pregnancy. 



MANAGEMENT OF PREGNANCY. 2$ 

known as the English catheter, will be necessary. 
Nos. 8 and 9 are those ordinarily used. 

Sometimes irritability of the bladder is due to Excessive 

J acidity of 

excessive acidity of the urine. A physician will urine - 
generally prescribe some alkali to overcome this 
condition, as a drop of liquor potassa in a table- 
spoonful of milk once in three or four hours, or the 
use of mucilaginous drinks, as flaxseed tea, barley 
water, milk, etc., may relieve the distress. 



Fig. 




Abdominal Belt. 



When the abdominal walls are much stretched Use of 
and the uterus falls upon the bladder, this may be 
remedied by the use of the binder or an abdominal 
supporter. 

Incontinence of urine leads to the excoriation Excoriation 

of vulva. 

and reddening of the parts about the vulva. Fre- 
quent washing with warm water and borax or pure 
castile soap relieves the irritation. Diachylon or 
zinc ointment is best when an ointment is needed. 



26 



OBSTETRICAL NURSING. 



Over-dis- 
tention of 
bladder. 



Use of 
catheter. 



The 

kidneys. 



Albumin- 
uria. 



Examina- 
tion of urine 



Increase in 
amount of 
urine. 



Incontinence is sometimes the result of over- 
distention of the bladder. Here the use of the 
catheter is indicated. 

A nurse, unless thoroughly experienced, should 
never attempt passing the catheter in the case of a 
pregnant woman, as serious injury may be done to 
the soft parts in a bungling attempt. In all cases, 
she should have the sanction of the physician before 
so doing. 

The kidneys are especially subjected to pressure 
from the seventh to the ninth month of pregnancy. 
A passive congestion is thus produced, which may 
lead to the occurrence of albuminuria, or albumin 
in the urine. This is an evidence of a drain upon 
the blood which the physician needs to watch very 
carefully. It is customary, therefore, for physi- 
cians to examine the urine of patients whom they 
expect to attend, at least once a week, from the 
seventh month on to the termination of pregnancy. 
A specimen obtained by the use of the catheter is 
the best for the purpose, if the patient be troubled 
by a discharge from the vagina. 

There is a natural increase in the amount of urine 
passed by a pregnant woman, but the increase is 
mainly in the water. Therefore, the urine will be 
lighter colored than usual. The reaction of the 
urine should be acid. 

Should the reaction be alkaline, or the quantity 



MANAGEMENT OF PREGNANCY. 2J 

of urine diminished rather than increased in amount, 
the fact should be reported to the patient's physician. 
Leucorrhoea, a discharge from the vagina, com- Leucor- 

° # . rhoea. 

monly known as "the whites," is much increased 
often during pregnancy, and is due to the greater 
activity in the secretion of all the mucous mem- 
branes. If a vaginal discharge be of a white, yellow 
or green color, it indicates inflammation of the 
vagina itself. The discharge, on reaching the vulva 
and coming in contact with the air, decomposes and 
becomes irritating. Cleanliness is important in over- 
coming the effects of this. The itching induced by 
it is sometimes very obstinate, and generally worse 
at night. A solution of borax and water for bath- 
ing the parts, or carbolic acid, 15 to 20^ to a 
pint of water, will often give relief. Should vaginal 
injections be ordered by the physician, they should - 
be given with great caution. A fountain syringe 
should be used, which produces a continuous stream. 
The interrupted stream should never be employed. 
In some conditions of excessive discharge the 
physician may prescribe tannic acid suppositories to 
be used nightly in the vagina. After a thorough 
drying of the parts surrounding the vulva, they may" 
be dusted with a powder consisting of one part 
powdered camphor to four parts starch. This often 
gives great relief. Calomel powder may be used in 
the same way. 



28 OBSTETRICAL NURSING. 

Hemor- Hemorrhoids, or piles, are often very trouble- 

rhoids or i • i 1 r t 

piles. some during the latter part of pregnancy. Lying 
down immediately after a movement of the bowels, 
and remaining in the recumbent position for ten to 
fifteen minutes, will tend to relieve them, also care 
in obtaining a daily evacuation of the bowels, and 
the use of means to secure as soft a movement as 
possible. Should the piles come down they should 
be fomented by cloths wrung out in warm water, to 
which a little Pond's Extract or fluid extract of 
hamamelis may be added — one tablespoonful, or 
two, to one pint of water — and when shrunken, 
anointed with cold cream or cosmoline and re- 
turned into the bowel. 

Sometimes the case is so aggravated as to neces- 
sitate keeping the patient in bed for a time. A 
physician should of course be consulted about the 
treatment. • 

Swelling of The swelling and pain of the external organs of 
' generation and of the lower limbs, resulting from 
pressure and the over-distention of the blood 
vessels, is best relieved by the recumbent posture. 
Should the veins of the leg be much enlarged, 
"or the feet swollen, the patient should have com- 
pression made over them by the application of a 
bandage (the spiral-reverse of the lower limb), or 
she should wear an elastic stocking, such as may 
be obtained of any good instrument maker. For 



MANAGEMENT OF PREGNANCY. 



2 9 



the bandage the best material is flannel cut bias, 
the width being about three inches. The bias 



Fig. 2. 




Spiral Reverse Bandage of Lower Extremity. 

bandage makes more even compression. Great 
harm may result from the neglect of enlarged 



30 OBSTETRICAL NURSING. 

veins, as they sometimes become so distended 
as to burst. 
Pain from Pain caused by the stretching of the walls of the 

distention of J ° 

w b a n°s minal a bdomen may be relieved by thorough inunction 
of the skin. Cotton-seed, olive or cocoanut oil 
may be used for the purpose. 

back 5 m Severe pains in the back, neuralgic in character 

and so severe sometimes as to prevent the patient 
from sleeping, may yield to change of position, 
relieving pressure. Rubbing with soap liniment, 
volatile liniment, whiskey, or any liniment not too 
active, is helpful. Warm hip-baths may sometimes 
be prescribed by a physician. 

increased The salivary Hands are in some cases very active 

activity of J ° J 

s f nd ry during pregnancy, inducing so excessive a secre- 
tion of saliva as to . cause the patient great annoy- 
ance. This trouble is generally very intractable, 
and may refuse to yield to all treatment, ceasing 
only with parturition. Astringent washes, as of 
tannic acid, alum, myrrh, etc., may be tried, as also 
the use of pieces of ice. Physicians sometimes use 
atropia in small doses. Its use requires careful 
watching. 

Bad teeth. Bad teeth, which occur so often during preg- 
nancy, are said to be due to acidity of the saliva, 
A little baking soda or prepared chalk placed in 
the mouth at night will counteract the effect of this 
acidity when it exists. The question is often asked 



MANAGEMENT OF PREGNANCY. 3 1 

whether there is any danger in having the teeth Filling or 

. drawing of 

filled or attended to during pregnancy. I here is teeth during 

pregnancy. 

always some danger, because a certain amount of 
nerve-irritation is the result. If the patient be suf- 
fering, however, it is better to have them filled by 
a temporary rubber filling, which causes little pain 
or irritation, than to lose rest in consequence of 
toothache. Extraction of the teeth should only be 
allowed when absolutely essential. If the pain be 
simply a neuralgic pain, it is better to wait. 

Vomiting is, as has been said in the preceding vomiting of 

1 , , r pregnancy. 

chapter, a most common accompaniment of preg- 
nancy. It more frequently exists, perhaps, with the 
first pregnancy than any other. The act is accom- 
plished, as a rule, without much effort. Diet seems 
to have but little effect upon it. Various articles 
have been recommended for it, as rice-water, beef- 
tea, barley-water, the various gruels, the yolk of a 
hard-boiled egg y scraped beef in the form of sand- 
wiches, ice-cream, cracked ice, etc. In some cases 
one or other of these seems to relieve the irritation. 
A cup of coffee, weak tea, or milk taken warm early 
in the morning before the patient raises her head 
from the pillow, will often act as a preventive. In 
extreme cases of vomiting rectal feeding must be 
resorted to. In obstinate vomiting it is important 
that the physician should examine for the position of 
the uterus or the existence of ulcerations or erosions. 



32 OBSTETRICAL NURSING. 

It must not be forgotten that the constant loss of 
food may be so great a drain upon the patient's 
strength as to endanger her life. As this symptom 
is so largely sympathetic, the proper use of bro- 
mides or other nerve sedatives prescribed by a 
physician may be of great use in checking it. 
care of the Care of the breasts in a pregnant woman neces- 

breRSts 

sitates careful attention to the prevention of com- 
pression. Full development should be permitted 
by the looseness of the clothing. The importance 
of the proper dressing of growing girls cannot be 
overestimated in this connection. Did mothers 
realize the evils — of which the atrophy of the breasts 
is but one — resulting from tight lacing, there would 
be fewer unhealthy women and fewer mothers 
unable to nurse their offspring. The nipples 
should be prevented from rubbing, and the skin 
over the nipples should be strengthened by using the 

ni lebath^PP^'k^h — filling a small, wide-mouthed bottle 
one-third full of cold water and inverting it over 
the nipples daily, from five to ten minutes at a 
time. Sometimes a little cologne-water or alcohol 

Use of on * s a( ^ded to the nipple-bath. Keeping off scabs and 
concretions of various kinds from the surface of the 
nipples by the use of a little oil is also admissible. 

Nipple The use of the nipple-protector, which will be 

protector. 1 

referred to more fully in the chapter on the man- 
agement of the lying-in, is of great importance 



MANAGEMENT OF PREGNANCY. 33 

where there is a tendency to flattening of the 
nipple, to remove the pressure of the clothing. 

The clothing of a pregnant woman should be clothing. 
worn loose from the very beginning, both because 
the breasts begin to enlarge early and corsets inter- 
fere with their development, and because any 
amount of pressure upon the intestines tends to 
produce uterine displacements, which are especially 
dangerous during pregnancy, as they predispose to 
abortion. The clothing should all be supported 
from the shoulders. 

Fig. 3. 



Nipple Protector. 

Many new dress-reform systems are now in Hygienic 

J J dressing. 

vogue, having for their object the great desideratum 
of adjusting woman's dress so as to make it both 
healthful and beautiful. Fortunately, in this enlight- 
ened age ideas of physical culture are so modifying 
old-time ideas of beauty that the wasp waist, the 
multitudinous and voluminous skirts, the awkward 
and deforming bustle, the high-heeled boot, are fast 
becoming relics of the past. Among the dress- 
reform systems now in existence there is none so 
fully meets my views of healthful and beautiful dress- 

3 



34 



OBSTETRICAL NURSING. 



ing as the Jenness-Miller System. But few gar- 
ments constitute the costume, and these are so 
constructed as to allow perfect freedom of every 
part of the body. 



Fig. 4. 



Fig. 5. 





Jenness-Miller Divided Skirt. 



A complete costume for sum- 
mer wear, according to this 
system, would consist in the 
chemilette — a combined chemise 
and pair of drawers — around the 
waist of which buttons may be fastened, to which 
the second article of dress, the divided skirt or 
Turkish leglette is buttoned. The latter is made 



Jenness-Miller 
Chemilette. 



MANAGEMENT OF PREGNANCY. 



35 



so full that it takes the place of petticoats, and the 
dress may be comfortably worn over it. Should 
the dress be of some very sheer material, one addi- 
tional muslin petticoat may be worn, similarly 
fastened to the waist of the chemilette. If a person 



Fig. 6. 



Fig 





Union Undergarment. 



Jenness-Miller Leglette. 



is accustomed to wearing merino or silk underwear 
both summer and winter, the jersey-fitting union 
under-garment may be worn beneath the chemilette, 
or, the latter being dispensed with, the Jenness- 
Miller " model bodice," or the Equipoise waist and 



$6 OBSTETRICAL NURSING. 

divided skirt, may be worn alone over the union 
under-garment. 

For winter wear, plain leglettes of flannel, cash- 
mere or silk, or the same material as the dress, may- 
be worn over the union under-garment and directly 
beneath the dress. Thus under-skirts are entirely 
dispensed with and all the clothing is supported 
from the shoulders. 

The skirts of winter dresses, being comparatively 
heavy, should be fastened to a waist of their own 
which has comfortably-cut armholes. 

Garters fastened to the waist are discountenanced, 
according to this system — as they should be, for 
they produce too much dragging on the waist, and 
the spiral-spring Duplex Ventilated garter is recom- 
mended to be worn until something better is devised. 

It is probable that the fashion will come into vogue 
of combining the stockings with the union under-gar- 
ment, when garters will be done away with entirely. 

Slender women can well wear the chemilettes, 
dispensing with all boned waists. Stout women, 
having busts, find more comfortable the model 
bodice, or the Equipoise waist,* which, I believe, is 
not one of the garments of this system, but an 
exceedingly comfortable one, in my opinion. Mrs. 

* This, with the other garments mentioned, may be obtained 
through the Dress Reform Emporium in Philadelphia, or similar 
agencies in other cities. 



MANAGEMENT OF PREGNANCY. 



37 



Jenness-Miller is now devising some form of breast 
support which aims to support the weight of the 
breasts from the shoulders, so that waists contain- 
ing bones may not be regarded as a necessity, even 
by the stout. Both the " model bodice" and Equi- 
poise waist (the latter of which I prefer) contain 
bones, but dispense with the front steels, so injurious 
in the ordinary corset. 




The Equipoise Waist. 



For the changes in shape induced by advanced 
pregnancy the union under-garments will need to be 
of larger size than those ordinarily worn (about two 
sizes larger). Many beautiful designs for dresses 
and other outer-garments have been devised by Mrs. 
Miller, patterns for which may be obtained of the 
Jenness-Miller Co., in New York, or its agencies in 
other cities. Before leaving the subject I would 
mention, as one especially praiseworthy feature of 



38 OBSTETRICAL NURSING. 

this system, the perfect use of the arms permitted 
by the ingeniously devised patterns for sleeves and 
shoulder straps. 
Abdominal When the abdominal walls are much relaxed, from 

binder. • ' 

stretching, allowing the womb to fall forward, it is 
well to use an abdominal binder or belt, especially 
during the last month of pregnancy. This helps to 
keep the uterus in proper position. 
Flannel Flannel should be worn — at least during 

underwear. 

pregnancy — both summer and winter. A lighter 
flannel can be substituted in summer for that which 
would be worn in winter. The use of flannel is to 
prevent chilling of the surface, and this is especially 
important where — as in pregnancy — the kidneys are 
overworked. It is important also for the condition 
of the heart and lungs. Coughs often cause pre- 
mature labors. The jersey-fitting knit union under- 
garment, before referred to, may be obtained in all 
grades and sizes and is well suited to the purpose. 
Bathing. Bathing is very necessary for a patient during 

her pregnancy as at other times. As regards the 
character of the bath, she can do as she has been 
accustomed to, using warm or cold water. A 
change from warm to cold water, or vice versa, is, 
however, not allowable. A sponge-bath, followed 
by brisk rubbing, is the most desirable. The skin 
is thus kept in good condition. Shower-baths 
should be avoided. 



MANAGEMENT OF PREGNANCY. 39 

Sea voyages are injurious, because of the danger sea 
of receiving falls or blows in consequence of the 
motion of the vessel, and also because of the lia- 
bility to sea-sickness induced by them. When it is 
absolutely necessary to take a sea voyage, there is 
probably least danger in the last three months of 
pregnancy, because the placenta, or afterbirth, is 
then well developed and its attachment to the 
uterus close. 

The regulation of the diet during pregnancy is Diet during 

** fe r fc> / pregnancy. 

of great importance. A patient should eat heartily 
for breakfast and dinner, but the evening meal 
should be light, especially from the seventh month 
on to the close of pregnancy. This meal should 
consist of stale bread, with butter and cooked fruit, 
as stewed apples, and a glass of milk or weak tea. 
Digestion is less active in the latter part of the day, 
and often a hearty meal may prove the direct ex- 
citing cause of convulsions. The food should be 
plain, wholesome, nourishing, well-cooked, and 
chosen in each case with special reference to the 
avoidance of digestive disturbances and constipa- 
tion. Meat in moderate quantity, broths, milk, 
eggs, and fresh fruit should constitute an important 
part of the dietary. Pastry and confections should 
be avoided. 

There is a mistaken theory prevalent in this day Frllit diet * 
that a mother, by abstaining from certain kinds of 



40 OBSTETRICAL NURSING. 

food, as meat, eggs, milk, etc., and confining herself 
chiefly to a fruit diet, may thus, by preventing tlie 
hardening of the bones of the child, do away 
largely with the pains of labor. The truth of the 
matter is this : that during pregnancy all the func- 
tions of the mother's body are especially active in 
promoting the development of the child, hence an 
insufficient supply of essentially nourishing food 
will first affect the mother's system and render her 
unfit for the demands upon her strength at the time 
of parturition. 

Should a restriction to the fruit diet effect what 
it is claimed to do as regards the infant, it would 
result in the production of sickly, rachitic children, 
poorly developed mentally and physically. 
Exercise. Moderate exercise is essential during pregnancy. 
Walking on a level, not riding, is the best form of 
exercise. A daily walk should be taken, not, how r - 
ever, after nightfall. The patient should avoid lift- 
ing — in fact, all straining movements — and most 
particularly should she avoid the use of the sewing- 
machine. 



CHAPTER III. 
ACCIDENTS OF PREGNANCY. 
A discharge of blood from the womb, known as Hemor- 

• rhage. 

" uterine hemorrhage, may occur at any time dur- 
ing the pregnancy, and is usually a sign that the 
patient is threatened with a miscarriage. However 
slight the flow, the nurse should have the patient Recumbent 

° ' L position. 

lie down until the doctor has been told of its occur- 
rence, and decides what the patient should do. A 
note should be sent to the doctor, telling just what plysidan. 
has happened, and clearly making him understand 
the urgency of the symptoms— that is, the amount 
and character of the flow — and the condition of the 
patient. A nurse should not trust to a verbal mes- 
sage, as the physician may fail to respond to the 
call promptly, not being aware of the urgency of 
the symptoms. The patient should be required to 
use the bed pan, or, at least, a vessel the contents 
of which can be thoroughly examined, both for the 
bowels and the passage of urine. All discharges, Preserva . 
soiled clothing, clots, etc., should be carefully saved dTschfrges. 
for the inspection of the physician. 

Meantime, an effort should be made on the part Efforts of 

nurse to 

of the nurse to control the flow. The patient should control flow. 

41 



42 



OBSTETRICAL NURSING. 



To prevent 
fainting. 



Vaginal 
injections. 



\ 

Causes of 
hemor- 
rhages. 



Unavoidable 
hemor- 



rhage. 



lie with her head low, and a pillow under her hips ; 
she should not be warmly covered, plenty of cool, 
fresh air should be admitted into the room and she 
should be kept exceedingly quiet. 

Should the symptoms become more urgent, the 
patient being threatened with fainting, the head may 
be low'ered by raising the foot of the bed, placing 
bricks or chairs under it in such a way as to make 
a decided inclined plane of the bed. The patient 
should be fanned, given hartshorne to inhale, and 
her limbs rubbed, to keep them warm, with alcohol 
or whiskey. Small doses of whiskey or aromatic 
spirits of ammonia may be given her in cold water, 
if able to swallow, or black coffee, or tea, not too 
warm. If there is much blood flowing from the 
vulva, vaginal injections of hot water, at a tempera- 
ture of about no° to 1 1 5°, may be kept up until 
the flow ceases. 

Alarming hemorrhages are often the result of 
accidents, falls or blows, or they may be caused by 
heavy lifting. 

Hemorrhage from a low attachment of the pla- 
centa, or afterbirth, or when the afterbirth occupies 
an unusual position — that is, at the side of or over the 
mouth of the womb — occurs without any history 
of accident. It takes place at any time from the 
seventh month of pregnancy on to its termination, 
and without any premonitions of its coming. It may 



ACCIDENTS OF PREGNANCY. 43 

occur at night while a patient is lying in bed. The 
management of this condition would be the same as 
that described above, until the doctor comes. 

Women suffering from enlarged, swollen veins, Hemor- 

° ' rhage from 

" varicose veins," or " varices," of the lower extremi- rupture of 

7 varicose 

ties, if not careful in keeping the limbs bandaged or vein - 
supported by elastic stockings, may have hemor- 
rhage occur by the bursting of one of these over- 
distended veins. The amount of blood lost may be 
so great as to imperil the patient's life. Should 
such a rupture of a vessel occur, compression should 
be made just below the point of rupture, to control 
the bleeding, until the physician, who should have 
been sent for, arrives, when he will resort to the 
measures necessary for securing against further 
hemorrhage. 

Miscarriages are apt to recur, hence a patient Miscar- 
riages. 
who has once suffered from one, should be cau- 
tioned to take additional care of herself during any 
subsequent pregnancy. Any sensation of weight ^ f re ^f" tion 
about the hips, with the recurrence of a " show," or carria s es - 
slight discharge of blood, and cramp-like pains 
should warn her to lie down and send for her phy- 
sician. Such a patient should also take the precau- Precaution 

1 *■ during men- 

tion to lie down as much as possible (if not in bed, struation - 

on a lounge) during the time when, under other 

circumstances, she would have her monthly flow. 

Any patient having had a number of miscarriages 



44 OBSTETRICAL NURSING. 

should keep herself under the care of her physician 
from a very early date in the pregnancy, being 
placed under a regular course of treatment. 
After-treat- it i s well, in this connection, to speak of the im- 

ment of mis- ' r 

carriages, portance of care in the after-treatment of miscar- 
riages. Not uncommonly, patients, especially of 
the working classes, get up and go about their work 
a day or two after the occurrence. This is a dan- 
gerous proceeding, for, though the ill-effects may 
not be felt for a time, chronic disease of the uterus 
is apt to result. 

Confinement It is really necessary to give more time to the 
recovery from the effects of an abortion, than to 
recovery fron) a confinement at term, and the pa- 
tient should be willing to remain in bed at least a 
week or ten days, or longer, if thought best by her 
physician. The patient should not leave her bed 
so long as any discharge of blood continues. 

Premature Premature rupture of the membranes enclosing 

rupture ot x ° 

membranes - the child, with a discharge of colorless liquid, com- 
monly known as" breaking of the waters," is another 
of the accidents of pregnancy, and is invariably 
followed, within a few days, at least, by the expul- 
sion of the child. The patient will complain of her 
clothing becoming wet, either by a sudden dis- 
charge of a quantity of liquid, or by a slow but 
continuous flow. The nurse can assure herself 
that this liquid is not urine by her sense of smell. 



ACCIDENTS OF PREGNANCY. 45 

The smell of urine is characteristic. With the am- 
niotic liquid surrounding the child, there is almost 
an entire absence of smell, a peculiar, faint, musty 
odor being alone recognizable. 

It is best, in removing this wet clothing from the ^jjjs for 
patient, to set it away, that the physician may judge inspection - 
for himself of the character of the liquid. The pa- 
tient should at once lie down, not taking the erect 
position for any cause, not even for defecation and 
urination, and the physician should be sent for, with 
a written statement as to what has occurred. It is 
important that the physician should see the pa- 
tient as soon after the rupture of the membranes as 
possible, because the sudden loss of water may have 
brought about changes in the position of the child 
which may endanger its life. The loss of the entire 
amount of liquid contained in the sac would cause 
also difficulties in the delivery, or what is known as 
"a dry labor." Dry labor. 

Convulsions may sometimes occur during the preg- Convui- 
nancy. The symptoms which threaten this trouble 
are extreme restlessness and uneasiness on the part 
of the patient ; severe headache, often confined to 
one side of the head; disorders of vision, as seeing 
things double, or seeing but the part of an 
object, sometimes very imperfect vision, and occa- 
sionally absolute loss of sight; twitchings of the 
muscles, especially of the face, may occur. The 



46 OBSTETRICAL NURSING. 

convulsion is ushered in by this restlessness and 
twitchings beginning first about the eyes and ex- 
tending rapidly to the mouth, arms and lower 
extremities. The movements are not violent, hence 
the patient is not likely to throw herself out of bed. 
The physician should be sent for ; meantime, the 
nurse should see that the patient is kept lying down, 
that her clothing is well loosened, especially about 
the head and chest, that plenty of fresh air enters 
the room, and that the patient is kept from biting 
her tongue. A folded handkerchief or towel 
slipped in between the teeth, pushes back the 
tongue and prevents the teeth from coming down 
upon it. 

The patient's feet should be kept warm and head 
cool. The members of the family must be kept 
calm and prevented from meddlesome interference, 
for the attempt to make the patient swallow any 
stimulant while struggling and unconscious, may 
result very disastrously. Should the attending 
physician live too far away or be delayed in coming, 
the nearest physician should be sent for. 



CHAPTER IV. 
PREPARATIONS FOR THE LABOR. 

The relations between nurse and patient begin 
from the time the engagement is made for a nurse's 
attendance upon the confinement. 

The nurse is generally consulted beforehand as Advice to 

° J patient. 

to the articles that will be needed at the time of 
the confinement and for the baby's outfit. Also, 
she is sometimes asked concerning the choice of a 
room for the labor and lying-in. 

The room is a most important consideration. It choice of 
should be light, having the free entrance of sun- 
light ; quiet and well ventilated. It should not be 
too near a water-closet ; in fact, it is far better to 
have the water-closet out of the house entirely. 
There should be no stationary washstand in the 
confinement room ; or, if this cannot be avoided, 
the connection with the sewer pipe should be cut 
off, or the holes and escape pipe in the basin 
plugged up, the basin being kept filled with fresh 
water frequently changed. No slop jar or any 
vessel containing wash water, discharges, etc., 
should be allowed in the room. An ounce of 
prevention, in the way of keeping disease germs 

47 



48 OBSTETRICAL NURSING. 

out of the room, is worth more than a pound 
of cure. 
Mother's As regards the mother's dress, she should be 

dress. . 

advised to have a sufficient number of good-sized 
merino or flannel vests, to be able to change night 
and morning, so that the same vest shall not be 
worn both day and night. These are more readily 
changed if opened all the way down the front and 
fastened with tapes. The free action of the skin 
after delivery necessitates the use of flannel or 
merino to prevent chilling. If a long night-dress 
is worn, there is no necessity for the chemise. The 
night-dress, also, should be opened all the way 
down the front, as it renders easier for the patient 
the frequent changes which are necessary. Suf- 
ficient night-dresses and vests should be provided 
to make it possible for the clothing to be changed 
every day. 
Abdominal Two or three abdominal bandages, also, should 

bandages. ° ' ' 

be provided, either fitted to the patient's person or 
straight. If fitted, the bandages should be pre- 
pared when the patient is about six months preg- 
nant, to be the right size after delivery. The 
bandages should extend from the pubic bone (the 
bone just above the external generative organs) to 
the breast bone, being about a half-yard wide and 
long enough to go once around the body and 
overlap one-third. It is best made of soft muslin 



PREPARATIONS FOR THE LABOR. 



49 



doubled, the seams being turned in at the edges. 
Large safety-pins should be provided for fastening 
this bandage down the front. 

Where the breasts are large and pendulous, some, Breast 

. bandages. 

bandage may be required for their support. An 
abdominal bandage may be used for this purpose, 
though it is rather wider than is necessary. 

When the physician does not require the anti- 



Fig. 9. 




Occlusion Dressing (Dr. Garrigues). 

septic dressings, now almost universally used, at 
least two dozen napkins of diaper linen should be Napkins 
provided for the mother, as very frequent changes 
of the napkin are essential during the first few days 
after the delivery, while the dischai ges are free. 

The antiseptic dressings used in the Woman's . . . 

* *=> Antiseptic 

Hospital, of Philadelphia, are essentially the same dressings. 
as those recommended by Dr. Garrigues, of New 
York, known as the occlusion dressing. They con- 

4 






50 OBSTETRICAL NURSING. 

sist of a piece of dry patent lint, 6x8 inches, which 
has previously been rendered antiseptic by satura- 
tion in a solution of bichloride of mercury i-iooo. 
This is placed, doubled in its width, so as to make 
a dressing, 3x8 inches, directly over the external 
organs of generation. This lint is covered by a 
piece of gutta-percha tissue, 4x9 inches, which is 
wet in a 1-4000 solution of bichloride of mercury. 

P ad ineal These dressings are kept in place by a napkin of 

sublimated cheese cloth, 18 inches square, folded to 
form a diagonal, 5 inches in width, within whose 
folds a pad of oakum is enclosed. The napkin is 
tightly fastened to the abdominal bandage, both 
anteriorly and posteriorly, by means of safety-pins, 
and the access of air to the vagina is thus pre- 
vented. These dressings are changed at least once 
in three hours, the dressing removed being at once 
burned. It is seldom necessary to continue the 
dressings longer than two weeks. They should be 
kept up, however, so long as the discharge persists. 

?eeded ty After the above statement, it will be seen that 
a nurse should have the patient obtain of each of 
the articles comprising the dressing the following 
quantity: Cheese cloth, 12 yards; gutta-percha 
tissue, 1 yard; patent lint, 2 yards; oakum, y 2 to 
I pound. 

obtSITed ^he cneese cloth may be obtained at any dry- 

goods store, and prepared by first thoroughly wash- 



PREPARATIONS FOR THE LABOR. 



51 



ing with soft-soap and boiling, and then wringing it Preparation 

of cheese 

out in a solution of bichloride of mercury 1-1000. ciothand 
The patent lint should be rendered antiseptic in the 
same way. The gutta-percha tissue, patent lint and 
oakum may be obtained at a drug store; the gutta- 
percha tissue may be more readily obtained directly 



Fig. 10. 






Nightingale Wrap. 



from a rubber store, where the syringe also may 
be bought. 

In winter it is well for the mother to be provided Nightingale 

*■ wrap. 

with a " nightingale wrap." This is made of two 
yards of flannel of ordinary width. A straight slit, 
six inches deep, is cut in the middle of one side, 



52 OBSTETRICAL NURSING. 

the points so formed being turned back to form a 
collar. The corners farthest from this collar are 
also turned back to form cuffs. The whole may 
be bound or pinked around the edge and fastened 
by means of buttons or ribbons. 
dothforcon- For the confinement bed the patient should pro- 
figment ^^ two pj eces f ru bber cloth, a yard and a half 
•square. For a single bed two rubber army blan- 
kets may be used, if, as in the maternity practice in 
the Woman's Hospital, it is desired to cover the 
whole bed. The arrangement of the bed will be 
explained in a later chapter. White rubber gum- 
cloth is the best when it is obtained in the piece. 
If the patient is poor, table oil-cloth may be used ; 
it is cheaper and answers the purpose as well, or 
layers of newspapers tacked together will make 
very good temporary pads. 
^uTth ^ piece of floor oil-cloth is the best protection 

for the carpet at the side of the bed. 
Precautions. Rubber-cloth should never be used but for one 
confinement. The rubber cracks when folded and 
put away and no longer serves its purpose of pro- 
tecting the bed. Then, too, it is very important to 
be sure that everything about the confinement bed 
is perfectly fresh and clean. Hence, a rubber-cloth 
used for confinement should neither be borrowed 
nor lent. 

Sleeping on rubber-cloth makes a person per- 



PREPARATIONS FOR THE LABOR. 53 

spire, hence it is desirable to get rid of it as soon Effect of 

. 1 sleeping on 

as one can. It is seldom necessary to use it after rubber 

.11 cloth - 

the fifth or sixth day. 

Other articles necessary to have on hand will be 0t ^ r e 

* articles tor 

half a dozen old sheets, about a dozen towels, a confine - 

1 ' ment room. 

new syringe (a fountain syringe, large size, is the 
best), a bed-pan (French pattern), nail-brush, white 
Castile soap, a jar of cosmoline or vaseline. 

I desire, in this connection, to emphasize the fact ^f nge . 
that the syringe should be a new one. This is an 
antiseptic precaution. Hence, advise the patient 
strongly against the use of any syringe which may 
have been used for other purposes, however well it 
may work. Of course, the borrowing of such an 
article from a neighbor or friend should be strongly 
discountenanced. 

Regarding the baby's clothes — if they are made Jj^^ s 
too elaborate they will not be washed often enough, 
hence they should be plain. As the depressing in- 
fluences of cold are very injurious to babies, the 
clothing should be warm, hence a flannel garment 
with long sleeves and high neck should be worn 
next the skin — the thickness varying with the sea- 
son of the year. The activity of the life processes 
make it important that every organ of the body 
shall be unimpeded in its action and free from press- 
ure, hence the clothes should be very loose and 
light in weight. 



54 OBSTETRICAL NURSING. 

Outfit for The only articles absolutely needed to constitute 
an outfit are, 1st, a soft flannel shirt, with high 
neck and long sleeves, opened in front. This is 

The under- better than the merino vests or the knit shirts, 

vest. 

which shrink on washing, and are then difficult to 
put on and take off. 2d. A binder, or bandage of fine, 
soft flannel, four inches wide, and long enough to 
go around the abdomen once and lap over about 
one-third. This should be made without a hem, 
the raw edge being overstitched to prevent raveling. 

The binder. The binder is best fastened by means of two pieces 
of tape attached to one of its edges. 

This arrangement does away with the necessity 
for pins in fastening the binder, the pieces of tape 
being simply wound around the body to secure the 

Knitted binder and tucked in at one edge. Some prefer the 
knitted wool band, made of single zephyr and 
knitted in the ribbed stitch, as wristlets or mittens 
are often knit, to permit of greater elasticity. These 
bands are made a little narrower in the centre than 
at either extremity, so as to be held in place better. 
They are made perfectly circular, just like a wrist- 
let, and are so elastic that they can readily be drawn 
up over the limbs and adjusted to the body. 3d. A 

Napkins. r . . 

napkin of cotton or linen diaper is the best ; Can- 
ton flannel makes a very poor baby's napkin, as it 
becomes stiff when washed. Napkins are generally 
made too large for a new-born baby, and require to 



ng 



PREPARATIONS FOR THE LABOR. 55 

be folded into too many thicknesses. A napkin, 
which when folded once is half a yard square, is of 
ample size. The number of napkins supplied 
should be generous, so as to permit of frequent 
washing and thorough airing. Napkins should 
always be fastened by safety-pins. For the protec- S^JfjJ l n 
tion of the outer garments from dampness due to^ r °™ 
frequent urination, it is well to have a second napkin 
folded and laid beneath the baby's hips. The use 
of rubber-cloth over the napkin for this purpose is 
much to be condemned, as it overheats the parts 
and makes the skin tender. 4th. A flannel slip of Flannel 
heavier or lighter texture, according to the season, 
serves the purpose both of petticoat and dress. 
This should be made just long enough to cover* 
the baby's feet — about twenty-five inches from 
neck to hem, and should be fastened in front. 
The ordinary fashion of making a baby's clothes ga^nts!" 
very long is objectionable because of the greater 
weight of the clothes preventing free movement of 
the child's limbs and the development of its mus- 
cles. The object of fastening the clothing in front 
rather than in the back is to avoid the necessity of 
the baby's lying on the uneven surfaces produced 
by buttons, tapes and hems, which no doubt are 
often a source of discomfort to its tender skin. 
5th. Knit woolen socks are necessary to keep theSocks. 
baby's feet warm, and it is well to have them 



56 



OBSTETRICAL NURSING. 



Support 

from 

shoulders. 



extend pretty well up the leg, reaching even to the 
knee ; as cold feet are often an exciting cause for 
colic. 

The above are the only essential articles of cloth- 
ing for a baby. Should the mother prefer, for the 
sake of effect, to see her baby in white muslin, a 
Muslin slip. s lip G f muslin can be worn over the flannel slip. 
These garments do away with all waistbands and 
the constriction of the chest thereby induced. 
Should the garments be made with waistbands, 
they should be supported from the shoulders by 
means of straps, or armholes should be made in 
the bands just as in the case of an older child; 
they will not need then to be drawn so tightly 
around the child to be retained in place. 

A blanket is not needed to wrap the baby in, in 
a room at the temperature of the lying-in room — 
from 68° to jo° ; but should it be carried from one 
room to another, or when it sleeps, a blanket, or 
some wrap, ranging in weight with the season, will 
need to be thrown over it. 

When a baby has but little hair on its head, and 
shows a tendency to catch cold readily, a plain 
cambric or light flannel cap may be employed as a 
head covering. This is a preventive against ca- 
tarrhal troubles affecting the nose and throat. 

A recent journal has described an outfit for babies 
which has obtained much favor among mothers. 



Blanket 
wrap. 



Cambric 
cap. 



PREPARATIONS FOR THE LABOR. 57 

It is called, I believe, the " Gertrude Suit," and con- "Gertrude" 
sists of three garments ; the first, or undergarment, 
is made of soft flannel, and is long enough to ex- 
tend from the neck to ten inches below the feet. 
The next garment, cut in the same way, but a half 
inch larger and five inches longer, is made of mus- 
lin. Over these comes the "slip," also Princess 
style, and the only one of the garments with long 
sleeves. (This is the most objectionable feature of 
the suit ; a baby's arms should be well covered.) 
It has a longer skirt than either of the other gar- 
ments. All are fastened behind by small buttons. 
These three garments are put together and all 
slipped on to the baby at one time, facilitating the 
process of dressing very much. 

In our opinion, however, this suit has not the A 

1 ' ' Advantages 

same advantages as that worn in the Maternity HoT°i?ai n ' s 
of the Woman's Hospital of Philadelphia, and first outfit - 
described. The fastening of the clothing in front, 
the fewer number of articles comprising the ward- 
robe, and the fact that they may be very easily 
taken off and put on, while they meet all the re- 
quirements of warmth, looseness and lightness, 
make this outfit preeminently a comfort to the baby. 

The articles provided for the baby-basket may be ^ticks for 
the following : — basket - 

Three or four pieces of linen bobbin, about eight 
inches long. 



58 . OBSTETRICAL NURSING. 

A pair of blunt-pointed scissors. 

Large and small safety-pins. 

Several small squares of soft linen, about four 
inches square, for dressing the cord, and two inches 
square, for washing the eyes and mouth. 

A soft hairbrush. 

A powder box and puff, with lycopodium or fine 
starch powder. (The scented powders are often 
irritating.) 

A small jar of cold cream. 

Two soft towels. 

A full suit of clothes, as described above, for the 
baby. 

A woolen shaw T l or wrap. 



CHAPTER V. 

SIGNS OF APPROACHING LABOR— THE PROCESS 

OF LABOR. 



Certain changes take place during the latter part*? 



Indications 



ap- 



of the ninth month which indicate that labor is i P a r b a r ching 
approaching. * One of these is the sinking of the sinking of 
abdominal enlargement. The upper part of the enlarge- 1 * 
womb, which has at the beginning of the ninth men 
month been high enough to reach the pit of the 
stomach, comes down gradually to a point about 
midway between the extremity of the breast bone 
and the navel. This sinking of the womb is known 
as " descent" or " settling" of the child, and indi- 
cates that the head of the child, which is ordinarily 
the part to be born first, has stretched the lower 
part of the womb and is finding its way into the 
cavity of the pelvis, through which it must pass in 
the birth. Great relief to the mother results from breathing. 
this descent of the womb, as the lungs are no 
longer pressed upon to the same extent as before. 
The change in the position of the womb produces, 
however, an increased amount of pressure on the Swellin of 
lower portions of the body. Swelling of the lower \° r ^ r J*] 
limbs is apt to result in consequence of this, and p°™ sure . 

59 



pains. 



60 OBSTETRICAL NURSING. 

Piles. walking is rendered difficult. Piles or hemorrhoids 
are apt to form, and irritability of the bladder to 
exist. 

During the last two weeks of pregnancy patients 
False" are a pt ^0 suffer from what are known as "false 
pains." These are cramp-like pains, so much like 
labor pains that patients are often deceived by 
them, and led to imagine that the labor is really 
coming on. They are called " false pains " to dis- 
tinguish them from the pains of labor, which are 

pains. known as "true pains." The way to distinguish 
between the two kinds of pains is to observe 
whether there is any regularity as to the time of 
their occurrence; also, whether the interval grows 
shorter, and whether, with this shortening of the 
interval, the pains grow stronger. "False pains" 
are irregular in their occurrence, while " true 
pains," though starting perhaps at quite long inter- 
vals, as three-quarters of an hour or a half-hour 
apart, gradually come nearer together and grow 
stronger. " False pains," also, are generally located 
in the abdomen. " True pains " more frequently 
start in the back, coming forward to the abdomen 
and extending down the thighs. A strong "pain " 
is apt to be followed by one or two weaker pains. 
A nurse, if in doubt as to whether the pains are 
real labor pains or not, should have the physician 
sent for, who will make an examination to learn 



THE PROCESS OF LABOR. 6 1 

what the condition of the parts may be. A sign 
that makes it probable that the labor is really 
coming on is the appearance of what is known as 
the "show," a discharge of mucus, tinged with 
blood, which comes from the mouth of the womb, 
and indicates that the stretching of the mouth of 
the womb is taking place. 

The whole process of labor is divided into three f^ s of 
stages. The first is the stage of dilatation, when First stage. 
the mouth of the womb is stretching so as to allow 
the child to pass through it. With women who 
have never borne children, this stage lasts on an 
average fifteen hours, while it is a very variable 
period for those who have previously borne chil- 
dren — sometimes lasting but three or four hours ; 
the average time given is from seven to eleven hours. 

The second stage of labor begins after the com- second 
pletion of the stretching of the mouth of the womb, stage ' 
and ends with the birth of the child. For women 
with their first birth, this period lasts from an hour 
to an hour and a half; with others, from twenty 
minutes to an hour. 

The third stage of labor includes the interval Third 

*=> stage. 

between the expulsion of the child and the coming 
away of the afterbirth — on an average a half an 
hour or twenty minutes. 

The time for the entire labor, in a case where it 
is the first birth, is about seventeen hours. In 



waters 



62 OBSTETRICAL NURSING. 

cases where other children have previously been 
borne, the average is from eight to twelve hours. 
Bag of The "bag of waters" is a sac of membranes in 
which the child is enclosed. Within this bag is 
found a liquid in which the child floats. The 
presence of this liquid between the child and the 
walls of the womb serves to protect it from the 
effect of falls or blows to which the mother may be 
subjected, and favors the regular development of 
the child. When labor begins with the stretching 
of the mouth of the womb, a small portion of this 
sac is pushed out like a wedge beyond the rim of 
the dilating orifice, and helps thus in the dilatation. 
When the waters break early, labor is much more 
tedious because the even pressure of the bag of 
waters on the mouth of the womb is lost, and the 
stretching cannot, therefore, go on so rapidly and 
easily. As the mouth of the womb opens, the 
pouch formed by the bag of waters is pushed 
further and further out into the vagina, the pains 
become stronger and the pouch at last bursts, 
letting the water escape. This is "the breaking of 
the waters," called by physicians the " rupture of 
the membranes," and it should not take place be- 
fore the mouth of the womb is fully open. 
Premature Labor, however, sometimes begins with this loss 

rupture of 7 7 ° 

the mem- f wa ter, as has been said in the chapter on the 

branes. ' x 

accidents of pregnancy. 



THE PROCESS OF LABOR. 63 

The pains of the first stage of labor are cutting, 
grinding pains, very hard for the patient to bear, 
and causing her to be nervous and irritable. 

The cries made by the patient during: the first Criesof 

y x ° patient in 

stage of labor are very different from those of the labor - 
second stage. They are cries of complaint and suf- 
fering, while during the second stage they are rather 
groans accompanying a bearing-down effort on the 
part of the patient. The pains of the second stage 
are called " forcing" or " bearing-down pains." An 
experienced woman will know, as soon as these 
pains begin, that the doctor should be on hand as 
soon as possible ; and she should send him a mes- 
sage which will lead him to realize the necessity for 
coming at once. 

The pains during the second stage increase in c u hangein 

■l o fc> character 

strength and frequency, the patient holds her breath of pains - 
and bears down forcibly with each pain. The effort 
causes her to become flushed and heated, and to 
break out into perspiration. Preparation 

During this time the head of the child is forced °rack r for 
down the middle passage, or vagina, to the exter- of child. 
nal opening. At the end of each pain the head 
goes back a little, so that the birth-track may be 
very gradually stretched. With women who have 
previously borne children, there is often so much 
relaxation of the tissues forming this passage-way 
that the head of the child may be expelled by a 



6 4 



OBSTETRICAL NURSING. 



single pain. This sudden birth of the head often 
causes very serious tears. 
Birth of After the external opening has been sufficiently 

child s head. a o j 

stretched by the slow advance of the head, it grad- 
ually works out altogether, and then the worst pain 
is over. There is then a short interval of rest be- 
fore the remainder of the body is born, the shoul- 
ders coming first by a strong pain, after which the 
lower part of the body easily slips out. 

The contraction of the womb, or " pains," now 

cease altogether from five to twenty minutes or even 

half an hour, when there is again a little pain and 

the afterbirth comes. 

Liability of The above description is an account of what labor 

accidents 

occurring, should be if perfectly natural. There are many 
emergencies which may arise in any case, hence, 
im ortance f° r ^ e sa k e °f both patient and nurse, every effort 
phys^dan to should be made, even in what promises to be a 
spo^iblnty. normal case, to have the doctor on hand in time. 



Expulsion 
of rest of 
body. 



Expulsion 
of after- 
birth. 



CHAPTER VI. 
DUTIES OF THE NURSE DURING LABOR. 

With the occurrence of the symptoms which call for 
indicate the onset of labor, the nurse, if not already 
in the house, should be immediately sent for. 

A nurse should give very prompt attention to Necessity 

° . . f° r prompt 

such a call, and lose no time in getting to the attention to 
patient, as many women pass through the different 
stages of labor very rapidly. 

On arriving at the patient's house, the nurse ££?£££' 
should put on her working-clothes, which should 
always be scrupulously clean and of wash material. 
The uniform worn by the nurses of the Woman's 
Hospital, of Philadelphia, consists of a blue and 
white striped seersucker dress, very plainly made ; 
a large plain white apron, with bib, well protecting 
the dress ; over-sleeves, of same material as apron, 
for the protection of the dress-sleeves, and a white 
muslin Normandy cap. This makes a plain yet T 

J V r J Importance 

attractive dress — which is a matter of .considerable ? fneatnes , s 

in personal 

importance to the patient, who gets her first impres- a PP earance - 
sions of her nurse through her personal appearance. 
Woolen dresses, or those made of any material 
which will not bear frequent washing, should never 
5 65 



66 OBSTETRICAL NURSING. 

importance be worn by a nurse. There is always the possibility 
wash dresses — in fact, the probability — of such a dress having 

in nursing. 1-1 1 

been worn during her attendance upon some pre- 
vious case of illness, in which case it would greatly 
endanger the patient. The feeling of the wash 
dress as it comes in contact with the patient's skin, 
when the nurse lifts her or works about her, is 
much more agreeable than that of woolen stuffs. 
Then, too, it is more business-like, looks more like 
work, and gives the patient the comfortable feeling 
that a nurse means to help her, rather than to sit 
around as a fine lady, attending simply to the 
daintier parts of attendance upon the sick. I intro- 
duce this subject here because I find that many 
graduate nurses, in breaking their direct connection 
with their training-schools, set aside as a matter of 
small moment this requirement concerning dress 
— a requirement in which a most important prin- 
ciple is embodied and which demands the hearty 
support of every truly scientific nurse, 
importance Another important point I wish to mention here, 
quick1y. mg and that is, that a nurse should learn to dress 
herself quickly, so that she can slip into the neces- 
sary garments in a very few minutes, and thus, by 
her promptness in reporting for duty, awaken 
the confidence so essential to her management of 
patients. 

On entering the room where the patient is to be 






DUTIES OF THE NURSE DURING LABOR. 67 

found, while exchanging the necessary greetings, First duty 
the nurse should exercise her powers of observation, room. tenng 
and rapidly take in the state of affairs, forming her 
opinion as to how far the labor has probably pro- 
gressed. Should "pains" be occurring, she will 9 bserva - 

** r . tion of 

recognize, from what has been said in a preceding "P ains -" 

chapter of the pains characterizing the different 

stages of labor, whether the patient is really in 

labor or not, also, how much time is probably left 

for the making of preparations. She can learn from when pains 

the patient, in the intervals of her suffering, when e§an * 

the pains first began, how often they occur, whether 

the waters have broken, etc., so that she may know 

what message to send the doctor, should the neces- Sending for 

the 

sity exist for so doing. After this duty has been physician. 
performed, if labor has really begun, the nurse 
should give herself to the preparation of the patient 
and the room for the confinement. 

Preparation of the patient: The nurse should Preparation 
inquire of the patient whether her bowels have been of patient " 
freely moved recently. If not, a simple enema of 
soap and water may be given for the purpose of Attention to 
clearing out the lower bowel and making the 
second stage of labor easier and cleaner. 

Inquiry should be made as to whether the patient A 1 tt ^ tion to 
has passed water freely. If not, she should be urged 
to make the attempt, and, if not successful, the 
physician should be notified. 



68 



OBSTETRICAL NURSING. 



Fresh 
clothing. 

Antiseptic 

vaginal 

injection. 



Warm bath. It is desirable, if there is time, to have the patient 
take a full warm bath and put on entirely fresh 
clothing. 

A vaginal injection of some antiseptic solution may 
then be given, and the parts about the external gen- 
erative organs washed off with an antiseptic solution. 
In the Woman's Hospital the vaginal injection con- 
sists of a solution of bichloride of mercury 1-8000. 
The external parts are washed off with a similar 
solution of 1-2000. 
Preparation Tablets of bichloride of mercury maybe obtained 
soiuuX tlc a t any apothecary's, one of which, if added to a pint 
mercury. 6 ° of water, will give, as a rule, a solution of 1-1000, 
from which solutions of varying strength may be 
made up by the addition of more or less water. 
Thus, on adding seven parts of water to one part of 
the bichloride solution 1-1000, a solution of 1-8000 
may be obtained. It is always desirable that the 
nurse should have a little porcelain or agate-ware 
gill measure, by which she can readily and quickly 
prepare these solutions. If tablets cannot be 
obtained, powders of J]/ 2 grs. each of bichloride 
of mercury, if added to a pint of water, will give a 
solution 1-1000. 
Creoiine. Creoline, a coal-tar preparation, four times 
stronger in its antiseptic properties than carbolic 
acid, may be used in a two per cent, solution, in 
place of bichloride of mercury. To make this, 



DUTIES OF THE NURSE DURING LABOR. 69 

2^/ 2 drachms of the creoline should be added to the 
pint of water. Creoline, though not so strongly 
antiseptic as bichloride of .mercury has greatly 
come into favor of late, both because it does not 
have the same corroding effect on instruments 
which may be used, and because there is less liabil- 
ity of poisoning than in the use of bichloride of 
mercury. 

A nurse should never lose sight of the fact that Danger of 
the corrosive sublimate (bichloride of mercury) 
tablets are a deadly poison, hence there should be 
no neglect as to care in their handling. 

Carbolic solutions are used in place of either Carbolic 

~ acid. 

of the above by some physicians. A two per 
cent, solution of the latter may be made up in the 
same way as the creoline. solution. 

When the patient seems to be in active labor, the Position 

until after 

nurse should keep her lying down until after the lamina- 
physician has made an examination. He will then 
state whether the patient may sit up or walk about 
the room. 

Because of her long confinement to bed the hair Arrange- 
of the patient should be arranged so that it will be hair. 
most comfortable and not readily tangled. The 
best arrangement is that of parting the hair down 
the back of the head and braiding it into two plaits 
— one behind each ear. This leaves a smooth sur- 
face at the back of the head to lie upon. 



yO OBSTETRICAL NURSING. 

Confinement The outfit of the patient during the labor 
should consist of a merino vest, long night- 
dress, a pair of large, roomy, open drawers, and 
a pair of stockings. While walking about the 
room, and until the second stage of labor begins, 
she can w r ear a wrapper over the rest of her 
clothing and have on a pair of bedroom slippers, 
which can be easily slipped off when she needs 
to lie down. 
fo? C ex S amI- The patient should be told by the nurse of the 
physidan. necessity for an examination by the physician, par- 
ticularly if this is her first labor. When the physi- 

x rc Octroi™ 

tions for this cian comes, the patient should be placed on the 

examination. • i 1 • 111 • 1 1 

bed, near its edge, lying on her back or side, as he 
may prefer, with her limbs drawn up toward the 
abdomen. Her clothing should be lifted above the 
hips, and a sheet, or some light covering, used to 
protect the lower part of the body from exposure. 
A chair should be placed for the physician on the 
same side of the bed, close to its edge, facing the 
patient as she lies ; a jar of cosmoline or vaseline 
should be brought him, and all the necessary mate- 
phy^dan's rials provided for the proper cleansing of his hands 
both before and after the examination ; soap, nail- 
brush, warm water and towels, and some disinfect- 
ant solution, as a bichloride of mercury solution of 
the strength 1-2000, or creoline, a drachm to the 
pint of water. 



DUTIES OF THE NURSE DURING LABOR. 7 1 

The preparation of the room and bed will next Preparation 

, , . . of room. 

require the nurse s attention. 

These preparations should be made as quietly as Systematic 

rr^i iii arrange- 

possible. The nurse should have learned before- ment of 

articles 

hand where things are, and she should have had needed - 
them so arranged that but little will need to be 
done at the time, except to put them where they 
will be most convenient for use. It is well, if the 
patient is walking about, to have her go into the 
next room while the bed is made up. 

A single bed is always the most convenient in o/l^ngie 11 
the management of a patient, but such are rarely bed ' 
found in private houses. The preparation of a 
single bed would be as follows : First, the mattress 
— preferably of hair — covered by a pad and rubber- 
protective across the middle of the bed, or cover- 
ing the bed entire (rubber army-blankets are used 
in the Woman's Hospital for this purpose). The 
under-sheet covers this rubber, and a draw-sheet — 
a sheet folded four times in its length and placed 
across the portion of the bed upon which the hips 
would rest — comes next. (The folded side of the 
draw-sheet should be toward the head of the bed). 
This constitutes the first dressing, or what is known 
as the " permanent bed." The different articles ne nlTed> 
constituting this dressing are securely fastened 
down by safety-pins. Over the " permanent bed " 
comes the "temporary bed," consisting of a second ^ e b m P^" 



J2 OBSTETRICAL NURSING. 

gum blanket, covering the entire bed, a second 
under-sheet and draw-sheet. Covering these are 
the upper sheet, blanket and spread. 

After the confinement, the " temporary bed " can 
be drawn from under the patient, leaving her lying 
on the " permanent bed." The change is accom- 
plished with much greater ease for both patient 
and nurse than the changing of the various articles 
separately. 
o/douWe 011 The double bed found in most private houses is 
arranged as follows : First, the ordinary dressing 
of the bed, the hair-mattress, pad, rubber-protective, 
under-sheet and draw-sheet. Upon top of this 
dressing, at the lower right-hand corner of the bed, 
"Tempo- a ''temporary dressing" should be arranged, about 
dressing." a yard and a half square, consisting of a rubber 
protective, or the paper pad before described, se- 
curely fastened down to the bed beneath, and cov- 
ered, if rubber, simply by a folded sheet, likewise 
fastened down by safety-pins. If the paper pad is 
used, an old comfortable or blanket will be needed 
beneath the sheet. The pillow for the patient should 
be placed at the upper and inner corner of this 
square. After the delivery, she can be lifted to the 
upper part of the bed, and the " temporary dress- 
ing " removed. 

The sheet, blanket and spread which are to serve 
as her covering after the delivery can be kept from 



DUTIES OF THE NURSE DURING LABOR. 73 

soiling during the labor if folded upon themselves Temporary 

1 i'ii r arrange- 

several times and carried to the extreme edge of ment of 

covers. 

the left side of the bed. Another sheet and blan- 
ket may be used as temporary covering during the 
delivery. It is so important that a patient shall be 
moved as little as possible immediately after the 
labor, because of the tendency to bleeding pro- 
duced by motion, that the nurse should study 
carefully the best methods of protecting patient 
and bed from soiling, so that it will be neces- 
sary to do but little in the way of changing the 
clothing. 

The piece of floor oil-cloth must be spread at Protection 

1 of floor at 

the side of the bed, extending from a foot to a foot side of bed. 
and a half under the bed. 

There should be a bureau with a set of drawers, s y stem in 

1 arranging 

or a closet, with shelves, in the room, given up to ^1? in 
the nurse for the keeping of the various articles drawers - 
she may need, and these articles should be conven- 
iently arranged so that there may be no confusion 
in obtaining them when required at any time. One 
drawer or shelf should contain sheets ; another 
towels and napkins and soft, clean. muslin or linen 
rags, to be used as napkins during the delivery ; 
a third should contain changes of underwear for 
the patient, and a fourth the baby's wardrobe. 

A change of clothing for the mother should b e ^Xng°for 
placed — if it is warm weather — in the sun by a mother - 



74 OBSTETRICAL NURSING. 

window ; if in winter, by the register, or stove, so 
as to be dry and warm should it be needed. 
Articles for The baby's suit should in the same way be aired 

baby's J J 

basket. anc ] warmed. The baby's basket should be placed 
on a chair or stand near the register, with all the 
necessary articles for its toilet and bath: — a baby's 
bath-tub or an ordinary foot-tub, soft towels, nurse's 
flannel bathing-apron, a little rendered lard in a jar, 
etc. Two pieces of bobbin, each eight inches in 
length, should be put in a little vessel containing 
some bichloride solution, 1-4000. These, with a 
pair of blunt scissors, should be placed where they 
can be conveniently reached for the tying of the 
cord. Some small squares of soft muslin or linen 
should be placed where they will be convenient for 
the immediate cleansing of the child's eyes after 
* expulsion of the head. A flannel blanket or good 
warm flannel petticoat should be provided for re- 
ceiving the child upon its birth. The baby's crib 
should also be prepared for its reception. 

Receptacles Beneath the bed there should be two chambers 

needed. 

— one for urine and one for the afterbirth, or a tin 
basin may be provided for the latter. 
For doctor's Some receptacle should be in readiness for the 

instruments. 

doctor's instruments, should they have to be used. 
The small pitcher which ordinarily accompanies 
the modern chamber sets serves this purpose 
very nicely. 



DUTIES OF THE NURSE DURING LABOR. 75 

A vessel for the patient to vomit in should be Receptacle 

on hand — a chamber, or even chamber-lid, will do to vomit in. 

very well. 

A basin filled with a warm solution of bichloride For anti- 
septic 

of mercury, i-4.oooor 1-2000, should stand near the solution - 
bed, so that the nurse or physician may repeatedly 
cleanse the external organs of generation of all dis- 
charges during the progress of the labor. The 
solution in this basin should be frequently changed. 

A sufficient number of soft linen or muslin rags ^//n 611 or 
will also be necessary for this purpose. pieces. 

Agate, porcelain or china basins are necessary Kind of 
when bichloride solutions are used. For creoline needed. 
ordinary tin basins will do. 

The nurse should never allow anything from the 
kitchen to be pressed into service for such an occa- 
sion. The indiscriminate use of pans, basins, cups 
and saucers is certainly vulgar, to say the least. 
The " eternal fitness of things" should never be 
lost sight of. 

A urinal, or a soap-cup, which is a. good substi- Qther 
tute ; a silver catheter, and an English rubber cathe- needed. 
ter, No. 8 or No. 9 ; a bed-pan ; . and the other 
receptacles for the various purposes above referred 
to, may be placed for convenience beneath the bed. 

A towel-rack near by should contain at least 
half a dozen fresh towels. 

A few napkins, a supply of soft rags, a jar of cos- 



j6 OBSTETRICAL NURSING. 

moline, a waste-bucket or slop-jar, with a lid, should 
be found in the room ; and an abundant supply of 
hot and cold water. 
Plentiful As soon as the patient is known to be in labor, 

supply of x 

hot water, {he nurse should go to the kitchen to see that the 
fire is good, and that plenty of water is put on to 
boil. An arrangement should also be made by 
which some member of the family will be prepared 
to respond to the nurse's call for more hot water 
when it is required. The abdominal bandage for 
the patient, with a set of the dressings and a pin- 
cushion containing safety-pins, should be placed on 
the stand beside the bed. 

stimulants. A bottle of whiskey or brandy and one of harts- 
horn should be provided. 

A pitcher of cool water and a tumbler should be 
found in the room, as the patient may need a refresh- 
ing drink during the progress of the labor. A 
feeder is best provided for the patient's use, as she 
can then drink lying down. 

Arrange- The arrangement of the patient's clothes to keep 

pTtLn's them from soiling during the expulsive stage of 
labor, will require some care on the part of the 
nurse. The night-dress or vest should be folded 
or rolled up beneath the arm-pits and fastened with 
safety-pins over the right side of the chest. If the 
patient wears large drawers, no further protection 
than the cover-sheet may be necessary. Some pre- 



clothing. 



DUTIES OF THE NURSE DURING LABOR. JJ 

fer having a sheet adjusted around the waist, above 
the abdomen, and pinned under the clothing to the 
right side, the long end of the sheet which remains, 
and which should be the anterior part, is plaited 
up and fastened also beneath the right arm by means 
of safety-pins. The sheet thus resembles a skirt 
opened at the right side. 

During the early stage of labor the nurse will^^ 5 ^ 
need to encourage the patient, and by a sensible, stage S of rst 
quiet, yet cheerful bearing keep her strong. It is Encourage- 
of no use for patients to hold their breath and bear 111611 ^ 

Avoidance 

down during each pain in this stage, and nurses of bearing 
should never urge their patients to do so. It should efforts - 
be left to the physician to decide when bearing- 
down efforts are desirable. The pressure of the^ a r ^ ureon 
nurse's hand upon the back during a pain often gives 
great relief to the patient, while the occasional bath- 
ing of the face and hands with cold water is refresh- 
ing. Frequent sips of cold water may be permitted. 

Nourishment in the form of beef-tea, gruel, milk Nou 5 ish - 

> c> ment. 

and tea may be given from time to time if the labor 
be long. No stimulants should be given without 
the direction of the physician. 

Vomiting is a troublesome though not necessarily vomiting, 
a dangerous symptom during delivery. In fact, 
the relaxation it produces is often desirable. If it 
is excessive, however, a little iced soda water may 
check it. 



78 OBSTETRICAL NURSING. 

Cramps. Cramps in the lower limbs are a very frequent 

accompaniment of the second stage of labor. Re- 
lief may be obtained by stretching the limb straight 
out, gently rubbing the painful muscles, or grasping 
and holding them, 

Exclusion of Friends and neighbors should, if possible, be 

company. o > ir > 

excluded from a confinement-room. Their injudi- 
cious tales and expressions of sympathy are often 
absolutely painful. The nurse has to manage this 
with great tact. She can generally succeed best by 
stating to the friends that it is the physician's wish 
she should do so, and her relations toward the 
physician require that she should implicitly observe 
his directions. If the nurse does not allow herself 
to become familiar with her patients, but maintains 
a quiet dignity in the carrying out of her directions, 
her requests will generally be observed. 
Tact. Tact is a magic wand by which human beings 

can accomplish miracles in the way of subduing 
the obstinate. Happy is the nurse who possesses 
it ! The best rule for acquiring it is the Golden 
Rule, " Do unto others as you would that they 
should do to you." A strict observance of this 
will insure a kindness of tone and manner in the 
making of requests which will win consent when 
it would not otherwise be granted. 

One of the most important duties of the nurse 
during the confinement is the frequent changing of 



DUTIES OF THE NURSE DURING LABOR. 79 

napkins, draw-sheets, towels, etc., used about the changing 

1 r 1 . . of napkins 

patient. Also the frequent renewal of the antiseptic and other 

r antiseptic 

solutions to be used about her, or for the doctor's measures. 
hands. 

Antisepsis means, literally, " against poisoning," Antisepsis. 
and implies the careful removal of all sources of 
poisoning, such as would come from decomposing 
blood and discharges, or dirty articles. The physi- 
cian's and nurse's hands, therefore, require a special 
preparation for the labor in their thorough disinfec- 
tion. During the course of the labor the hands 
should be thoroughly cleansed with a bichloride 
solution whenever they have touched anything un- 
clean, or whenever they come in contact with the 
genital organs. 

The patient may be delivered on her back or J ,? 11 * 011 for 

1 J delivery. 

lying on her left side. When the physician desires 
the change of position, the nurse must help the 
patient to turn on her side and bring her hips close 
down to the edge of the bed. The upper or right 
limb will then have to be supported by the nurse, 
in order to well separate the thighs until the 
delivery is effected. (When there is insufficient help, 
a pillow may be used between the knees.) She 
will have to get on the bed close to the patient 
for this, and hold the leg at knee and ankle. After durtg^hird 
the child has come, she should help to turn theSS?. *" 
patient in the bed ; bring a flannel wrap to put the 



8o 



OBSTETRICAL NURSING. 



Removal 
of child. 



Prepara- baby in as it lies on the bed before the tying of the 
receiving cord, and throw a covering over the mother's chest. 
Protection She should then wipe the baby's eyes with a fine, 

of mother. ... 

cleansing soft piece of linen dipped in tepid water, or a saturated 
eyes. solution of boric acid ; should bring the doctor 

the scissors and bobbin ) and have ready a sheet 
for receiving the child, and a vessel for the after- 
birth. She should hold the sheet doubled upon her 
outstretched arms, the side toward her being held 
up by her chin. On receiving the baby with its 
flannel covering, she allows the edge of the sheet 
held up by her chin to drop down over the child. 
She then folds over the hanging ends, so as thor- 
oughly to cover the child, and places the little 
bundle in a crib, to await further attentions, until 
the mother has been made comfortable. Should 
the child breathe imperfectly, the physician will 
give it his own attention, or direct the nurse what 
to do. 

The vessel containing the afterbirth, if the latter 
has been detached from the child, may be placed 
temporarily under the bed, to await the physician's 
examination. If the cord has not yet been tied, 
the vessel may be put in the crib with the baby. 
Many physicians do not tie the cord or navel-string 
until there is no further pulsation in the vessels, 
cleansing Should the physician not desire to do so, the 
iabor? r< nurse should next attend to the cleansing of the 



Care of 
afterbirth. 



DUTIES OF THE NURSE DURING LABOR. 8 1 

mother's external parts by means of soft cloths 
dipped in a solution of bichloride of mercury' I- 
4000. 

Many physicians make a practice of using a vaei- Va s inal 

. . . . & & injections. 

nal injection of some disinfectant solution immedi- 
ately after delivery. It will be the nurse's duty to 
prepare this should it be called for. The " tempo- Removal of 
rary dressing " should be removed from the patient, cfolwng. 
and she should be gently lifted on to the upper 
portion of the bed. The binder and dressings f P bin C d a er° n 

. . i«i and dress- 

mUSt next be applied. in gs . 

" The binder must be rolled up to half its length, 
and the rolled portion passed beneath the patient's 
back. It is then caught on the other side and un- 
rolled, straightened so as to be free from wrinkles, 
and made to encircle the hips tightly. The over- 
lapping ends are then fastened together by means 
of safety-pins down the front." The middle portion 
of the bandage should be tightened first, as the firm- 
est pressure should be directly over the upper por- 
tion of the womb. The lower portion of the band- 
age is fastened next, and the pins in the upper por- 
tion placed last, as this does not need to be so 
firmly applied. 

The antiseptic dressings should next be applied 

in the order described in a preceding chapter. The 

napkin is spread out and fastened to the abdominal 

bandage anteriorly, so as to fit over the convexity 

6 



82 OBSTETRICAL NURSING. 

of the upper portion of the external organs of genera- 
tion, and extend from groin to groin. Posteriorly 
it is fastened to the abdominal bandage by but one 
safety-pin. This makes an " occlusion dressing." 
Making The patient's body-clothing should then be un- 

patient l J ° 

comfortable - fastened and drawn down (her drawers and stock- 
ings should have been removed with the "temporary 
dressing "). The coverings of the bed are drawn 
up over her, and she is allowed to lie quietly until 
the nurse cleans up the room and makes prepara- 
tions for washing the baby. 

Physician's The physician generally remains with the patient 
an hour after the delivery, taking her temperature 
and pulse, and watching the condition of the womb, 
to insure against danger of hemorrhage from want 
of proper contractions. 

d^defafter After the doctor leaves, this duty devolves upon 

daVkave's. the nurse, who should examine the dressings fre- 
quently to see that the bleeding is not too profuse, 
and place her hand over the lower part of the abdo- 
men to feel the womb, which, if properly contracted, 
should be a round, hard body about the size of a 
child's head, immediately above the pubic bone, 
and not reaching higher than the navel. The con- 
sideration of the accidents of labor, and the care of 
the infant, will be treated in other chapters. 



CHAPTER VII. 

ACCIDENTS AND EMERGENCIES OF LABOR. 

Women who have borne children before are apt p^^n^ 
to have rapid labors, hence a nurse should be on delivery. 
her guard when in attendance upon such a patient, 
watching for the symptoms of approaching labor, 
and notifying the physician earlier than she would 
feel warranted in doing with a patient expecting her 
first confinement. As soon as the nurse suspects Occurrence 

of pains. 

that labor pains have begun, she should put her 
patient to bed. When "bearing-down " pains begin, ^ co e n ^ f 
the patient should not get up even to use the cham- labor * 
ber. A bed-pan should be used. The patient 
should not be allowed, when the pains come on, to 
catch hold of anything to increase the force of her 
effort. Above all, the nurse should not tell her to 
bear down. 

The strength of the pains is somewhat modified Lateral 

. r i . . -i ... r^* . . . position. 

if the patient is kept on her side. I his position 
is also safer for the perineum, which does not so 
directly get the full force of a pain as when the 
patient lies on her back. The left side is preferable, 
as it enables the nurse to use her right hand to 
greater advantage. 

83 



84 OBSTETRICAL NURSING. 

Care of Should the child's head come down so that it can 

perineum. , - i • 1 

be seen at the entrance to the vagina, the nurse 
should place herself on the right side of the bed, 
and as the patient lies on her left side, with the hips 
well drawn to the edge of the bed, the nurse should 
chnd' s r he°a f d g en tly hold back the baby's head during a pain. 
This is to prevent a tear from occurring by the sud- 
den expulsion of the head. She should favor the 
gradual stretching of the parts. She should avoid 
interfering in any way, as in making efforts to en- 
large the opening by stretching it with the fingers, 
etc. All such attempts will inevitably result in 
harm. When the opening is sufficiently stretched, 
headT ery ° f the head will slip out of itself. The passage of the 
child's head is rendered easier if the patient's knees 
are separated by a pillow. The nurse should sim- 
ply continue to support the head with her hand, 
and as soon as the head is born her left hand 
should be placed over the mother's abdomen, rest- 
Grasp of ing upon the womb, which may be distinctly felt 

uterus. 

through the abdominal walls. The pressure of the 
hand acts as a stimulant to the womb and induces 
good contractions. A tendency to hemorrhage is 
thus averted. The right hand of the nurse should 
support the child's head. With one finger she 
of co e rd. ng should feel around the baby's neck to learn whether 
it is encircled by a loop of the navel-string or cord. 
If so, she should gently pull first on one side and 



ACCIDENTS AND EMERGENCIES OF LABOR. 85 

then on the other of the cord, to see which end 
gives. This loosens the pressure and prevents the 
stoppage of the circulation in both cord and child's 
neck. 

When, after a pause, the pains start up again to J^ 6 ^ of 
expel the rest of the child's body, the nurse had 
better have some one instructed how to hold the 
womb properly, as both her own hands will be 
needed to receive the body of the child as it is ex- 
pelled. The mother herself may be shown how to 
make this pressure over the womb. If there is no 
one to make this compression of the womb, the 
nurse should try to manage the baby with one hand 
and keep up the pressure over the lower part of the 
abdomen with the other. The flannel wrap for the Care of 
baby may be put close up to the mother's hips, and 
the nurse can manage with one hand to lay the 
baby down on this, cover it up, and draw it far 
enough away from the mother's hips to keep it out 
of the discharges. She should see that the baby's 
mouth is free from liquids. The little finger of her 
right hand acting as a hook, the end of the finger 
should be passed in at one corner of the baby's 
mouth and out at the other corner, thus scooping 
out any liquids that may have been drawn in during 
the birth. She should be careful to see that the 
cord is not dragged upon and that the baby breathes 
well. Babies usually cry lustily just [after the 



86 OBSTETRICAL NURSING. 

birth. This should be a welcome sound to both 
nurse and mother, as it insures expansion of the 
lungs. Occasionally, a child will be born with what 

-caul" * s known as a "veil" or "caul," a portion of the 
membranes, drawn tightly over the face. This may 
cause death from suffocation unless it is quickly 
seized by the fingers and torn off, so as to free the 
child's mouth and nose. 

u e n l of Cita " "^ ^ e baby is apparently lifeless when born, be- 

infam. sides the measures spoken of for clearing its mouth 
of liquids, it may be turned over on its face, to 
empty out the discharges from the air-passages, 
and efforts should be made to start breathing. The 
head of the child should be lowered, to keep as 
much blood there as possible. 

The back may be slapped — several short, quick 
slaps given over the buttocks. A stream of cold 
water 'may be poured on the chest just for a 
moment, and this repeated several times. 

Artificial if these fail, the nurse may breathe into the baby's 
mouth. To do this properly, the baby's nose should 
be held, the nurse's lips placed closely over the 
baby's open mouth as she breathes into it, then 
the nurse's mouth is removed and the grasp on the 
nose loosened, the sides of the child's chest being 
pressed upon to press out the air. The number of 
breaths given by the nurse in a minute should not 
at first exceed twelve. 



ACCIDENTS AND EMERGENCIES OF LABOR. 87 

Another valuable method of carrying on artifi- Sylvester's 
cial respiration is known as Sylvester's method. 
The baby is placed on its back, with a roll made by 



Fig. 11. 




Sylvester's Method of Resuscitation (First Movement). 



a towel placed under its shoulders. The head is 
thrown back. The arms are then slowly lifted and 
carried well up over the head. They are held in 
this position until five can be slowly counted. By 



88 



OBSTETRICAL NURSING. 



this movement the ribs are elevated, the chest ex- 
panded and a vacuum produced in the lungs into 
which the air rushes ; or, in other words, the move- 



FlG. 12. 




Sylvester's Method of Resuscitation (Second Movement). 



ment produces " inspiration." The arms are then 
carried slowly downward, placed by the side and 
pressed inward against the chest. This forces out 
the air and produces " expiration," These move- 



ACCIDENTS AND EMERGENCIES OF LABOR. 89 

ments should be slow, repeated about fifteen times 
during each minute, and should be carried on until 
the breathing becomes regular. Should there be 
no sign of life, the efforts at resuscitation should not 
be abandoned for at least two hours after the birth. 

A third method, which, however, requires the ^ c e h t ^ e ' s 
separation of the baby from the afterbirth, is most 
excellent. It is known as Schultze's method. It 
would be more apt to be practiced by a physician, 
because it necessitates the early and quick tying of 
the cord, and is only of advantage when practiced 
at once after the delivery. The method is as fol- 
lows : The child is seized by the shoulders and 
upper arms and swung head downward above the 
operator's head. The weight of the lower part of 
the body is thus thrown upon the chest, and any 
liquids which may have been drawn into the air- 
passages are thus forced out. Being held thus for a 
time, while the operator counts five, the body is then 
brought down in reversed position between the 
operator's knees. The weight of the lower extremi- 
ties is thus made to drag upon the chest and enlarge 
its capacity for the entrance of air. These two 
movements may be kept up for considerable time.* 

"^The order of these movements as given by Schultze is reversed. 
The upward movement is practiced first in the Woman's Hospital, 
as it is found that the air-passages are thus best cleared of mucus 
and discharges before an act of inspiration is encouraged. 



9 o 



OBSTETRICAL NURSING. 
Fig. 13. 




Schultze's Method of Resuscitation (First Movement), 



ACCIDENTS AND EMERGENCIES OF LABOR. 9 1 



Fig. 14, 



C^ 




Schultze's Method of Resuscitation (Second Movement). 



92 OBSTETRICAL NURSING. 

Warm Alternating with artificial respiration, warm baths 

baths. _ . . 

maybe employed from time to time. Ihe tern- 
After-care, perature of the bath should be ioo° Fahr. After 
breathing is established, the child should be placed 
in warm wraps, with bottles of hot water around it. 

Sd gof *f a ^ * s we ^ Wlt ^ ^ e c hild, it is best not to tie 
the cord until all pulsation ceases in it. This 
measure is thought to save the child some loss of 
blood. As the pulsation may last for an hour or 
more after the delivery, the afterbirth is generally 
expelled before the cord is tied. To tie the cord, 
two pieces of bobbin, each eight inches long, dipped 
in a bichloride solution 1-4000, or in some other 
antiseptic solution, should be used. The first liga- 
ture should be placed three inches from the child's 
abdomen. The string should be carried under- 
neath the cord. In making the first tie, two twists 
instead of one should be taken to keep it from slip- 
ping. If the thumbs are placed upon the string in 
tying, the ligature can be drawn more tightly, and 
the grasp of the ends of the bobbin is more secure. 
The second knot is tied the same way. The ends 
may then be looped, making a bow-knot. The 
cord should be stripped, that is, the blood remain- 
ing in the vessels squeezed out toward the afterbirth, 
before each ligature is thrown around it. The 
second ligature is one inch further away from the 
insertion of the cord into the child's abdomen. 



ACCIDENTS AND EMERGENCIES OF LABOR. 93 

After this second ligature is tightened, hold the 
cord with the forefinger and middle finger at the 
ligature nearest the child, the thumb and other 
fingers at the other ligature, and cut it with a pair 
of dull scissors between these points. The extrem- 
ities of the scissors are thus made to look toward 
the palm of the hand, and a sudden movement on 
the part of the child does not result in the same 
danger to it, as there would be were the points not 
thus protected. After the cord is cut, squeeze the 
remaining blood out from the end next the child. 
The scissors for this purpose are preferably dull, as 
the more ragged wound thus produced favors the 
closure of the blood vessels. This lesson may be 
learned from nature, the lower animals gnawing off 
the cord after giving birth to their young, and thus 
no doubt decreasing the danger of bleeding. Position 

■ ^ ^ during third 

The best position for the mother during the stage of 
delivery of the afterbirth is on her back, hence, 
she may be turned after the nurse has satisfied her- 
self that the baby is in good condition. Twins. 

Very occasionally, on placing her hand over the 
abdomen, after the delivery of the child, the nurse 
may feel another child there. In this case she must 
simply keep the womb well contracted by rubbing 
it gently through the abdominal walls, and wait for 
nature to go on with the work of expulsion. This 
baby must be cared for as the other. 

The afterbirth generally comes away within a fterbirth° 



94 OBSTETRICAL NURSING. 

twenty minutes after the child's birth. Two or 
three pains occur, during which the nurse should 
keep the womb in the middle line of the abdomen 
and make gentle pressure backward and downward. 
With her right hand she should seize the afterbirth 
and membranes and twist them around several 
times to make a cord of the membranes, so that 
they may not tear but all be expelled at once. A 
discharge of blood and some clots generally follows 
the delivery of the afterbirth. The nurse's left 
hand should still be kept carefully over the womb, 
which should feel hard and firm and should not 
reach above the navel. If it does not feel firm, rub- 
bing over the lower part of the abdomen should 
again be resorted to until the round, hard body is 
felt. 

If the afterbirth does not come for an hour, and 

the physician has not yet come, send for another 

doctor. 

Examina- After the afterbirth has come, it should be put 

afterbirth, in a clean vessel, and, if detached from the baby, 

put in an adjoining room for the doctor to examine 

when he comes. Insist upon his seeing it, to find 

out whether it is all there. Have the baby removed 

to its crib and placed on its right side and properly 

covered. 

Care after Watch the womb carefully until the doctor comes. 

third stage J 

of labor, if it be firmly contracted, and no more blood be 
flowing from the vagina, place some dry napkins or 



ACCIDENTS AND EMERGENCIES OF LABOR. 95 

a clean sheet under the patient, and wash off the cleansing of 

• 1 patient. 

thighs and surrounding parts with warm w T ater con- 
taining bichloride in the strength of 1-4000, and 
dry with a soft cloth. 

Slip the soiled clothing from under the patient, ^£i= e of 
and then apply the binder and dressings, and make Binder and 
her comfortable. 

• As soon as the doctor comes, report to him the Report. 
exact time when the waters broke, when the baby 
was born and when the afterbirth came. It is 
always best for a nurse to keep a written report 
with a statement of what she did. She should not, 
however, neglect her patient for the purpose of per- 
fecting her report. 

Sometimes a nurse has the misfortune to be Breech 
the only attendant at a breech delivery, that is, 
instead of the child's head coming first, the 
breech passes out from the birth-canal. Delivery 
in this manner is very dangerous to the life of 
the child. The nurse should do absolutely nothing 
here, as she would only make matters worse in 
trying to assist. These deliveries are long enough, 
as a rule, to give ample time for the summoning 
of some doctor to take charge of the case. In all 
breech cases the child is apt to need to be resus- 
citated, if it is alive at all ; hence plenty of warm 
water, etc., should be ready for the bath. 

Flooding from the womb, or " uterine hemor- ^ge°. r " 



g6 OBSTETRICAL NURSING. 

rhage," is apt to occur either within the first twenty- 
four to forty-eight hours after the birth, when it is 
called " primary hemorrhage;" or, it may occur 
some days after, when it is " secondary hemor- 
rhage." The appearance of blood, either a constant 
oozing or a sudden gush from the vagina, is, of 
course, the earliest symptom. 

A pulse of over ioo in a patient freshly confined 
should make the nurse exceedingly watchful in this 
respect, as it betokens a liability to hemorrhage 
Should the flow continue, the patient becomes pale, 
faint, restless, gasps for breath, and finally dies 
unless the hemorrhage is checked. A nurse should, 
of course, have the physician sent for at once, 
although he may have just left the house, or 
another doctor should be summoned. In the mean- 
time, her first thought should be of the uterus and 
its probable condition of relaxation. The bandage, 
if applied, should be hastily removed and the hand 
placed over the lower part of the abdomen. If the 
womb is not felt, rub vigorously until it contracts and 
is felt again as a round, hard body. Keep on rubbing 
and holding. The nurse should never take her 
hand off the abdomen until the doctor comes. 
Direct some one else to take the pillows from under 
the patient's head, have the foot of the bed elevated, 
to keep the blood in the head and prevent fainting, 
which induces heart-clot. Have the foot of the bed 



ACCIDENTS AND EMERGENCIES OF LABOR. g 1 / 

placed on the seats of chairs. The patient may be 
fanned, cold water given her to drink, hartshorn 
to smell. She should not be allowed even to turn 
in bed or lift her head. If the doctor has left ergot, 
one teaspoonful of the fluid extract may be given 
in a tablespoonful of water. The patient should 

Fig. 15. 




£= 






Position of Patient in Hemorrhage after Labor. 



receive this without lifting her head. Plenty of hot 
water should be on hand, the water in the tea- 
kettle boiling. If the physician delays his coming, 
and the flow continues, repeated hot-water injec- 
tions of about H5°-i20° should be given into the 
vagina. 

7 



98 OBSTETRICAL NURSING. 

Convulsions. Convulsions may come on during the labor as 
during the pregnancy. Their management would 
be the same as that suggested for convulsions 
during pregnancy. 

Rupture of Other accidents, such as rupture of the uterus, 

uterus. ' r y 

Prolapses, or the coming down of an arm or hand, or the 
navel-string in advance of the usual part to come 
first, are conditions in which the nurse can do 
nothing, except to keep the patient as quiet as she 
can, and meddle as little as possible until the doctor 
comes, for whom, of course, she must at once send. 

Demeanor At no time, in the management of a case, should 

of nurse. ' ° ' 

a nurse express surprise or consternation, nor 
should her manner indicate that she has such feel- 
ings. Like a true soldier, she must bravely and 
quietly face the most critical situations and meet 
their demands. She should by her manner give 
the mother to feel that all life's vicissitudes are best 
met by a quiet self-control. 

Liability to Fortunately, deaths during delivery in this en- 
accidents 
during lightened age are few ; for the methods of averting 

labor. & . & # ' *> 

accidents at such times have been so thoroughly 
studied, that accidents themselves are very rare. 
donsfor" As °P era tive procedures during the course of a 
Cperldons. delivery may have to be resorted to very suddenly 
and unexpectedly, a nurse should have things in 
readiness should the emergency arise. The especial 
preparations necessary will consist in the making 



ACCIDENTS AND EMERGENCIES OF LABOR. 99 

of a cone of stiff paper, into which a towel is fitted, 
for the purpose of giving the patient ether ; arrange- 
ments for an abundant supply of hot water, to be 
had at a moment's notice ; facilities for making up 
antiseptic solutions quickly; a small pitcher con- 
taining a warm 2 per cent, creoline solution for the 
physician's instruments ; some kind of grease, as 
carbolized cosmoline for lubricating these instru- 
ments when desired ; English rubber catheter and 
urinal conveniently at hand ; a basin with a 2 per 
cent, creoline solution for needles, sutures, and 
scissors ; absorbent cotton in small pads, or soft 
linen rags dipped in an antiseptic solution, to be 
used instead of sponges ; sufficient protection for 
the floor at the side of the bed ; and preparations 
for resuscitation of the infant. 

The position of the patient for most obstetric 
operations will be across the bed, with her hips well 
over the edge. This is called a " cross-bed." Physi- £ 

*> J "cross-bed.' 

cians generally call simply for a cross-bed, in desir- 
ing the nurse to make preparations for an opera- 
tion, and she should understand that this refers to 
the arrangement of protectives and sheets, adjust- 
ment of pillow, and placing of patient in proper 
position. Should there not be a sufficient number 
of persons to have one hold each leg, chairs should 
be placed in such a way at the side of the bed as to 
support the widely-separated feet. A chair for the 
physician should be placed between these, facing 



IOO OBSTETRICAL NURSING. 

the bed. As there is usually some assistant to 
give the ether, the nurse will need to help in keep- 
ing the limbs apart and in giving the physician any 
other aid she can in the supply of the various 
articles as they are needed. Should the physician 
desire her to give the ether, her whole attention 
should be devoted to administering the anaesthetic, 
and seeing that the patient keeps in good condition. 
Strict watch should be kept over the respirations 
and the pulse. Difficult breathing, or a stoppage 
in the respirations, weakness or irregularity of the 
pulse, blueness of the face and lips, should at once 
be called to the physician's notice ; the ether cone 
being removed from' the patient's face. After the 
patient is once well under ether, it takes but little 
to keep up the anaesthesia, so that a nurse should 
use the ether, sparingly; a few drops every few 
minutes upon the towel are, as a rule, sufficient. 
After etherization the patient may vomit, and there 
will be greater tendency to bleeding because of the 
relaxation induced by the anaesthesia, hence the 
nurse should exercise special watchfulness and care 
over the patient. The vomiting is often relieved 
by a mustard paste over the stomach, while the 
bleeding may be controlled by the hand placed 
over the lower part of the abdomen, which, by 
making pressure over the womb, insures good con- 
tractions. After the nausea is relieved, ergot, if 
prescribed by the physician, may be given. 



CHAPTER VIII. 
CARE OF THE NEW-BORN INFANT. 

The mother being made comfortable after her 
delivery, the nurse should turn her attention to the 
infant. 

Everything needed for the baby's first toilet 
should be collected and placed conveniently at hand, 
near the register, stove, or open fireplace. 

The nurse should put on a flannel apron, or pin Prepara- 

1 . tions for the 

a crib-blanket or flannel petticoat over her lap. first bath - 
The best bath-apron is one consisting of two pieces 
of flannel fastened to the same waistband. The 
lower piece is the one on which the baby lies; the 
upper serves as a covering. A pitcher of warm 
water and one of cold must be provided, the baby's 
bath-tub being placed near them, the baby-basket, 
suit of aired clothing and jar of rendered lard or oil 
within reach. The nurse should pick the baby up 
with its wraps and place it in her lap as she seats 
herself on a low chair or stool near the fireplace. 

The baby will be found to be covered over por- vemix 

J A caseosa. 

tions of its body by a white, greasy substance, called 
" vernix caseosa," or " cheesy varnish." This sub- 
stance is found in greatest quantity on portions of 

IOI 



102 OBSTETRICAL NURSING. 

the body subjected to friction while in the womb, 
hence it serves to protect the child's skin. 

its removal. Some kind of grease is needed for its removal. 
Rendered lard and oil are the best. Cosmoline is 
not so good, as it is stiffer than the other two — not so 
soluble a fat. All this cheesy substance must come 
away with the first washing, as, if left, it irritates 
the skin and produces sores. The most difficult 
parts of the body to cleanse are the folds or creases. 
The nurse should take a piece of lard about the 
size of a walnut, rub it over the palms of both her 
hands, and then, taking the child's head between 
her hands, rub the grease thoroughly in, giving 
especial attention to the ears. A second piece of 
lard, of the same size, will be needed for the neck, 
shoulders, arms, chest and back ; a third piece for 
the groin, external generative organs, and lower 
limbs. The creases and folds about the generative 
organs, especially of a little girl baby, need very 
careful cleansing. When the baby has been thus 
thoroughly gone over, she should take the corner 
of a dry sheet and rub off the grease. Many phy- 
sicians prefer not having the baby bathed after this 
greasing. It may then be dressed and laid in its 
crib. 

The bath. Should the bath be preferred, the nurse should wrap 
the baby up in her flannel apron, draw the bath-tub 
toward her and prepare the bath, filling the bath- 



CARE OF THE NEW-BORN INFANT. IO3 

tub about one-third full of warm water at a tem- 
perature of ioo° F., tested by the thermometer. A 
wall-thermometer, costing fifteen cents, may be ob- 
tained at any drug-store for the purpose. The 
baby is then placed in the tub, its entire body, 
excepting its head, being immersed for a moment 
or two beneath the water. The nurse should keep 
the baby from slipping from her grasp by allowing 
its head to rest against her left wrist and hand, while 
the fingers of the same hand obtain a secure grasp 
under the child's left arm-pit. After the dip, the 
child is lifted out on to the nurse's lap again, where 
a soft, warm towel should have been spread for its 
reception. In this it should be wrapped and thor- 
oughly dried. Great care must be taken to see 
that the arm-pits, groins and other parts of the body 
where creases exist are entirely free from moisture. 
After the first bath, the child receives, as a rule, but 
a sponge-bath daily until the cord drops, when the 
daily plunge-bath may be given. The baby should 
always be thoroughly washed with simple warm 
water over the parts of the body soiled, every time 
the napkin needs to be changed. Soap does not need 
to be used. Its frequent use would irritate the skin, 
and the parts can be perfectly cleansed without it. 

The use of powder in the folds and creases of the Powder. 
body is not essential. The main object is to keep 
rubbing surfaces dry, and should the nurse properly 



104 OBSTETRICAL NURSING. 

attend to this duty after the bath, this, with- the use 
of flannel next the baby's skin, ought to be suf- 
ficient to effect the purpose. Should a powder be 
desired, some very fine, unirritating powder, such 
as lycopodium, might be used. Many of the 
scented powders contain substances which are 
irritating to the skin. 
Dressing After the baby has been dried, the stump of the 
cord or navel-string should be attended to. Make 
a loop of the stump, doubling it back upon itself, 
and tying it tightly by means of the ends of the 
bobbin left from the first ligature. Slit up a square 
of soft linen to its centre. It is well to have ren- 
dered this, antiseptic by dipping in a bichloride solu- 
tion i-iooo or 2000 before drying. Put this around 
the cord which is slipped through the slit (the slit 
looks upward toward the child's head), fold over 
the ends, and turn the whole upon the left side. 
Some physicians will direct that no dressing be 
placed around the cord. In fact, sometimes there 
is no ligature placed around it, but it is simply 
well stripped of the blood and jelly-like substance 
which help to compose it, and thus allowed to dry. 
The placing of the loop of cord with its dress- 
ings on the left side of the child's body is to avoid 
pressure upon the liver, which is larger than any 
other organ in the infant's body at birth, so large, 
in fact, as to extend quite down to the navel. The 



CARE OF THE NEW-BORN INFANT. 105 

abdominal bandage is put on over the dressing to 
hold the latter in place. 

Some use antiseptic gauze in the dressing of the 
cord. A drying powder, consisting of one part sali- 
cylic acid and five parts starch, is an antiseptic appli- 
cation which it is often desirable to employ. 

A clear substance exudes from the cord as it j^Jy rton ' s 
shrinks which wets the dressings, so that it is neces- 
sary to change the piece of linen quite often the 
first day or two. A cord kept dry by the frequent 
change of dressings will have no odor about it, and 
will drop, on an average, by the 'fifth day. The 
base from which the cord dropped may continue 
moist for a few days, and is best dressed by dusting 
over it a little of the starch and salicylic acid pow- 
der before spoken of, and placing a small compress 
of antiseptic linen or gauze over it. The navel-dress- Thebin der 
ing is kept in place by the application of the flannel 
binder, which should be carefully adjusted, so as not 
to compress the abdomen too tightly. After the 
bandage is fastened, the nurse's hand, used flatwise, 
should be easily slipped in between the bandage 
and the baby's skin. Should safety-pins be used in 
fastening the bandage, they should be placed in front 
and not at the back, or they may cause the baby 
discomfort in lying. The bandage fastened by the 
tapes, which is simply wound around the body, is 
safer on this account. 



106 OBSTETRICAL NURSING. 

Great importance should be given to the proper 
care of the navel, as it offers an open surface on the 
child's body through which poisonous matter may 
be taken into the blood, causing " infantile sepsis," 
or the blood-poisoning of infants. 

The napkin. Before the dressing of the cord, a napkin should 
have been laid beneath the hips of the infant, as 
there is very apt to be a free discharge of a dark, 
greenish matter from the bowels shortly after the 

"Slum." birth. This is known as " meconium." It should 
always come away within the first twenty-four hours 
after birth, and may continue to come at intervals 
for three or four days. When it does not come 
away freely, the baby may suffer considerable pain. 
A soap suppository or a small injection of warm 
water will bring about relief, causing an evacuation 
of the bowels. 

This substance is very difficult to wash out of 
napkins, hence, it is a good plan to have a soft piece 
of old muslin placed inside the napkin to catch the 
discharge. This may be burned when removed. 

o^refuT 6 The baby should be washed every time the nap- 

and^rem kin needs to be changed, even if it is only wet. 

napkins. Warm water should be used. A napkin should 
never be used twice without washing. The habit 
of hanging up a napkin wet with urine, allowing it 
to dry and using it again is not only filthy, but un- 
safe, as it renders the napkin irritating to the skin 



CARE OF THE NEW-BORN INFANT. 107 

and a source of possible septic infection. For the 
same reason a napkin should be changed as soon 
as it is wet or soiled. Though the work may be 
irksome, a nurse should not weary of it ; for it is 
only by eternal vigilance that the child can be kept 
in good condition. 

After the application of the binder and napkin, Under-vest. 
the baby's under-vest or little, long-sleeved, high- 
necked flannel shirt should be put on. This should 
be fastened in front by safety-pins, or small, flat 
buttons or tapes. 

If the shirt is too large, folds should be made at 
the sides to make it fit better ; never in the back, 
because of the ridge this would produce under the 
surface upon which the baby lies. 

The socks come next and then the flannel slip, socks and 

dress. 

constituting the only other garment the baby needs. 
The petticoat with slip, or Gertrude suit, may be 
used instead, if desired. 

The eyes and mouth should each be washed out Washin f of 

J eyes and 

with a separate soft piece of linen dipped in warm mouth - 
water. 

The baby's hair, if it has any, may be brushed t ^ r e u ^ g 
with a soft baby-brush. No comb should be used, 
as the scalp is too tender. 

The baby should then be placed in its crib, on its 
right side, and warmly covered. The weaker the 
baby is, the warmer it will need to be kept. Stone 



108 OBSTETRICAL NURSING. 

jars, when rilled with hot water, are nice for this 
purpose placed around the child, but care should 
be exercised not to let these bottles be placed so 
near as to cause a burn. 

In another chapter we will consider the care of 
premature infants. 
dL ei baby g The weighing of the baby devolves often upon 
the nurse. A steelyard being provided, the nurse 
may place the nude child in a napkin, tied or pinned 
securely at the corners. This napkin may be swung 
on to the hook of the steelyard as it is held up. The 
pointer will then indicate the number of pounds 
weight. The average weight of a new-born baby 
is 3250 grammes (about seven pounds). 

In the Woman's Hospital the ordinary grocer's 
pan-scales are used, the weights being represented 
in grammes. The daily weight is taken and recorded 
on a card which hangs by a ribbon or string to 
the baby's crib, so that its daily condition may be 
carefully watched. For a comparison of the approx- 
imate weights in the metric and avoirdupois scales, 
I append the following table of equivalents : — 

Relation of Avoirdupois to Metric Weights. 



AVOIRDUPOIS „_ „„. „ 

POUNDS. GRAMMES. 

1 453-592 

2 907.18 

3 • 1360.78 

4 1814.37 

5 2267.96 



AVOIRDUPOIS GRA MM E S. 

POUNDS. 

6 2721.55 

7 3175.14 

8 . 3628.74 

9 4082.33 

10 4535.92 



CARE OF THE NEW-BORN INFANT. IO9 

For the first three or four days a baby will lose Loss of 

. , , -i 1 . -. weight for 

weight, as it does not take in enough nourishment first few 

days. 

to make up for the loss it sustains by the newly- 
acquired activity of bowels, bladder and skin. At 
the end of the first week the baby should weigh 
about what it did at the birth. After that it should 
gain, on an average, thirty grammes a day (about 
one ounce). 

A sponge-bath is sometimes given the baby at The 
the close of the day, when its clothing is changed bath, 
for the night; but this is not necessary, if it has 
been properly attended to when the napkins have 
been changed. The fresh clothing at night is always 
essential. 

The baby's crib should have no rockers. All Thecrib - 
unnecessary swinging, rocking and jolting of babies 
only serves to make them nervous and more trou- 
blesome to take care of. A convenient and inex- Combine d 
pensive crib and bath-tub combined, especially for an^crib. 
traveling, is described in one of the numbers of 
" Babyhood," thus: "The frame is made something 
like a cot-bed. Straight pine sticks may be used. 
The legs, one inch and a half square by thirty inches 
long, are crossed and pivoted in the middle on a 
centre bar. The side bars, one inch by two inches 
and thirty-six inches long, are securely fastened to 
the top of the legs. Smaller bars join the legs 
near the bottom to stiffen the frame. A piece of 



no 



OBSTETRICAL NURSING. 



heavy rubber-cloth, one yard and a quarter long 
and thirty inches wide, has an inch-wide hem on 
each end for a casing, and is drawn up to eighteen 
or nineteen inches with heavy braid (a leather strap 
would probably be better). This makes the ends of 
the tub. Along the side bars of the frame are 
tacked, with brass-headed tacks, the sides of the 



Fig. 16. 




Home-made Bath-tub and Crib. 



cloth, the braid (or rubber straps) being securely 
fastened to the ends. A small plait in the cloth at 
each corner, about an inch from the end, gives a 
fuller shape to hold the water (when it is in use as a 
bath-tub). The tub (or crib), when not in use, can 
be folded and set away out of sight, or it may be 
carried in the bottom of a large traveling-trunk 



CARE OF THE NEW-BORN INFANT. 1 1 I 

when on a journey. The frame may be made of 
walnut or cherry, with turned legs, etc., if so de- 
sired. A pillow put in the tub makes a comfortable 
and portable crib for the baby." 

Children should never sleep in the same bed? e P a / ate 

r bed from 

with their mothers. It is unsafe because there is mother - 
danger of their being overlaid, and it is unhealthy 
because of the discharges, breath, etc., of the 
mother 

A baby may be trained to be contented andp rop er 
happy as it lies in its crib. If from its earliest days infants g ° 
it is taken up simply to be fed, and receive the 
necessary attentions for keeping it clean and com- 
fortable, it will not become the little tyrant a 
child develops into when foolishly spoiled by its 
mother. 

Babies should be fed but once in two hours Feedingof 
during the day, and every three hours during the infants - 
night, unless premature, when they can take less Time . 
and should be fed every hour. An interval is neces- 
sary between the feedings in order that the stom- 
ach may rest and be prepared properly to carry 
on its work of digestion. Hence, the habit some 
mothers have of letting babies nurse whenever they 
cry, simply serves to produce indigestion, as well as 
to spoil the child. 

For its first nursing the baby may be put to the First 

nursing. 

breast an hour or two after the labor, if the mother 



112 OBSTETRICAL NURSING. 

is sufficiently rested. The nipples should, before 
each nursing, be carefully washed off with cold 
water. The early secretion of the breasts, known 
as ''colostrum," helps to rid the baby's bowels of 
their dark, tarry contents, as it is laxative. It is 
important that the breasts should be used alter- 
nately in feeding the infant, as this allows a longer 
time to elapse for the accumulation of milk. For 
the first day or two the baby needs comparatively 
little food. Should it seem to be hungry, however, 
and the mother unable to satisfy it, a teaspoonful or 
two of warm water or diluted peptonized cow's milk, 
prepared according to the suggestions to be given 
later, may be administered at regular intervals. 

Before and after each feeding, the baby's mouth 
should be carefully washed out with a soft piece of 
linen dipped in warm water. This is to prevent the 
particles of milk remaining in the mouth from pro- 
ducing soreness by souring. 

a drink of Two or three times daily a baby should be given 

water. ^ teaspoonful of cool water to drink, as babies suffer 

from thirst just as their elders do. The cold water 

assists, also, in keeping the bowels from becoming 

constipated. 

insufficient Should the mother not have sufficient milk for 

milk. 

her baby, it may have the bottle every other time, 
the additional food being selected with reference to 
the child's age and powers of digestion. 



CARE OF THE NEW-BORN INFANT. II3 

When a mother has no milk, the best substitute The 

* 1111 wet-nurse. 

is a good wet-nurse. A wet-nurse should always 
be carefully examined by a physician, that her free- 
dom from disease may be fully determined before 
she is employed. She should be between twenty 
and thirty years of age, and have good, not neces- 
sarily large, breasts, well-shaped nipples, and an 
abundant supply of milk. The condition of her 
own child should be considered, whether it be 
thriving or sickly, and especially whether there be 
any evidence of special disease. It is well, too, to 
try to get a woman who has had more than the one 
child, as a woman who" has borne several children 
has, by experience, learned to understand and man- 
age babies. 

The first milk that comes in the breast, and which Fore-miik. 
appears in any quantity, about the eighth month of 
pregnancy, is called " fore-milk," or " colostrum," 
from a word which means "glue." It is turbid, 
yellowish, gluey, alkaline in reaction, and easily 
sours. It differs from' true milk in having a higher 
specific gravity, or weight; it also contains more 
salts and more albumen, and is more difficult to 
digest. It is laxative in its effect upon the baby's 
bowels. Physicians not unfrequently examine a Prognosis 

r 1 • • 11 • f° r nursing. 

specimen of this secretion under the microscope, to 
learn what the prospect is as to the mother's nurs- 
ing the child. If, in the last two months of preg- 
8 



114 OBSTETRICAL NURSING. 

nancy, the colostrum is scanty, and, under the micro- 
scope, there are but few oil globules, the patient will 
probably have poor milk and small in quantity. If 
the colostrum is abundant, but thin like gum-water, 
not gluey, and without yellowish streaks, it is prob- 
able that the milk will be watery and not nourish- 
ing. It may be either scanty or abundant. If the 
colostrum be plenty, with yellowish streaks and full 
of milk globules, the milk will be abundant and 

Duration of good in quality. The secretion of colostrum may 
continue from six to eight days. If it continues 
longer, it is a great disadvantage, and the mother 
may have to give up nursing because of the 
child's inability to digest the nourishment thus 
afforded. 

character- Human milk should have a specific gravity of 

istics of Jr o y 

JjjU£ an 1.032. It is alkaline in reaction; that is, it will turn 
red litmus-paper blue, and it contains the following 
ingredients : — 

Water, 829.08. 

Sugar, 46.64. 

Casein and Ext., 39- 2 4« 

Butter, 26.63. 

Salts, . 1.38. 

difference ft differs from cows' milk in having a higher spe- 

between o o j. 

human and c jfj c gravity, more solids, less water, and one-fifth 

cows milk. o J ' * 

the amount of casein. The effect of poor diet is to 
increase the water and diminish the butter and 



CARE OF THE NEW-BORN INFANT. 1 1 5 

casein, so that the milk becomes thin. The milk Regulation 
retained longest in the breast — the first milk to meet 

SDGC13.1 

drawn by the baby at each nursing — is the thin- demands, 
nest; the last, the richest. When, therefore, a 
baby seems to suffer from indigestion because of its 
mother's milk being too rich for it, it should take 
the first secretion from each breast at each nursing 
instead of drawing all the milk from one breast. 
One or two teaspoonfuls of water given the baby 
before each nursing have the same object. Should 
it, on the contrary, not seem to thrive because of 
the food not being sufficiently rich, the thin milk 
should be pumped or drawn out of each breast by 
the nurse or mother before the baby is allowed to 
draw. The two breasts are estimated to contain 
about two ounces of milk at one time. 

The question of how to increase the secretion of stimulation 

T- of increased 

milk is a very important one. The best way is by secretion - 
a judicious regulation of the mother's or wet- 
nurse's diet. There are no medicines which are 
entirely satisfactory for the purpose of stimulating 
the secretion. Therefore a nurse can do more than 
a doctor in this line by careful feeding of her pa- 
tient. A mixed diet is the best for making milk. 
Beer and all kinds of liquors, as porter, etc., do 
more to fatten the mother or nurse than to make 
milk ; therefore they are to be avoided. The spe- 
cial diet for a nursing woman is laid down in 



n6 



OBSTETRICAL NURSING. 



Testing 
milk. 



The lacto- 
meter. 



Fig. 17. 



another chapter. Good human milk should be 
three per cent, cream. 

To determine the character of milk — human or 
cows' milk — an instrument known as the lacto- 
meter, or milk-tester, may be used, aided by the 
microscope. 

The lactometer consists of a 
cylindrical glass vessel, or beaker, 
which should contain the milk 
to be tested, and a specific gravity 
glass, which is to be floated in the 
liquid. This glass is graduated 
and marked at certain points with 
certain letters and figures. Thus, 
W., P. and F. The W. stands 
for "water," P. for "pure," and 
F. for "fat." Between the W. and 
P., at different points, are the 



/ 



\ 




:> 



fractions. 



%> % 



Should the 



Lactometer. 



weighted glass sink in the liquid 
so that the surface of the liquid 
reached the mark W., the liquid 
tested would have the same specific gravity as water. 
Should the surface of the liquid reach the mark y> 
if it is milk that is tested, it would be y milk and 
y water. If the mark y 2 is touched, it is y 2 water 
and y 2 milk. In this way the adulteration of the 
milk with water is detected. Should the level of 



CARE OF THE NEW-BORN INFANT. II7 

the liquid stand at P., we would have pure milk. 
Pure cream would raise the weighted glass so that 
the level of the liquid would stand at F. An ordi- 
nary urinometer may be used to obtain the specific 
gravity of milk in a similar way. Dr. Louis Starr ^oT^" 
suggests a good way to discover the proportion of P f r °P^ on 
cream in any given sample of milk : A narrow 
piece of paper, four inches long, is divided in its 
upper half inch by cross-markings into twelve 
equal parts. This paper is then pasted on the 
beaker of the lactometer with the marked portion 
uppermost, the lower edge touching the bottom of 
the beaker. Enough milk is then poured in to 
come just to the top of the paper, and the whole 
set aside for twenty-four hours. The cream rises 
and appears as a yellow layer at the top. This 
layer should have the depth of ten or twelve spaces, 
as marked on the paper. 

On examination under the microscope, if there Micr .°- 

-l * scopic ex- 

are but few oil globules in a specimen of milk, and ^j^ 011 

if these oil globules be small, the milk is poor. On 

the other hand, if the oil globules in milk are too 

large, this becomes a cause for its indigestibility. 

Should menstruation begin with a nursing Effect of 

menstr , " , 

mother, the milk may be so affected as to disagree tion on 
with the child. Ordinarily, the menstrual flow 
does not recur until the eighth month after delivery. 
The appearance of the flow need not lead to a ces- 



menstrua- 
tion on 
secretion. 



n8 



OBSTETRICAL NURSING. 



Effect of 
pregnancy 
on 
lactation. 

Artificial 
feeding. 



Character- 
istics of 
cows' milk. 



Analysis of 
human and 
cows' milk. 



sation of nursing, unless the milk should seem to 
disagree with the child The character and quantity 
of the milk is impaired by deep or violent emotions ; 
thus, anxiety, fear, anger, etc., will greatly detract 
from a woman's ability to be a good wet-nurse. 
Pregnancy always deteriorates the character of milk, 
and is an indication for weaning a nursing child. 

When the mother's milk utterly fails, and a wet- 
nurse cannot be had, hand-feeding becomes neces- 
sary. For this purpose diluted, sterilized cows' 
milk may be used. 

Cows' milk has a specific gravity of 1.029. The 
milk obtained from stall-fed cows gives an acid re- 
action ; that from pasture-fed cows a less acid reac- 
tion. Could the latter be obtained directly from 
the cow its reaction would be slightly alkaline, as 
with human milk. An analysis of the same quan- 
tity of woman's milk and cows' milk is reported as 
yielding the following results : — 



WOMAN S MILK. 

Water, 87.88 parts. 

Total solids, . . .12.13 " 

Fat, . 4.00 « 

Albuminoids, . . . 4.00 " 
Milk-sugar, ... 7.00 " 
Ash, ...... 0.2 " 

Bacteria, not present. 



cows MILK. 

86.87 parts. 

13.14 " 
4.00 " 
4.00 " 

4.5 " 
0.7 
present. 



The woman's milk for this analysis was obtained 



CARE OF THE NEW-BORN INFANT. I 19 

directly from the breast. The cows' milk was, as 
it is ordinarily obtained in cities, about twenty- 
four hours old. 

By an. examination of this analysis, it will be seen Points of 

J ■ difference. 

that the proportion of coagulable substances of 
cows' milk is much greater than in human milk. 
This is where the difficulty in its digestion lies. 
Casein of human milk coagulates in light curds ; in 
cows' milk in firm, hard curds. Peptonizing digests 
the casein, while thickening milk with barley-water 
helps to separate the curd, so as to prevent the for- 
mation of large, hard masses. In peptonizing milk Pe P t( i niz a- 

fe ' r r fe tionofmilk. 

the following formula may be followed : — 

R . Ext. pancreatis, g j. 

Sod. bicarbonatis, gij. 

To 1 gill tepid water and 1 pint tepid milk. Let stand in a tem- 
perature of ioo°-iio°, Fahr., for half an hour. 

A preparation found especially useful in the feed- Food 

recipes. 

ing of infants is the following formula : — 

Peptonized milk, 6 tablespoonfuls. 

Milk sugar, y z teaspoonful. 

Barley-water, 2 tablespoonfuls. 

Lime-water, I tablespoonful. 

{Br. A.E.Broomall.) 

When milk has not been skimmed, the addition 
of cream to the feeding is not essential. As most 
milk brought to cities has been deprived of at least 



120 OBSTETRICAL NURSING. 

a part of its cream, various formulas have been 
suggested for producing mixtures which will re- 
semble human milk as closely as possible in their 
constituents. A favorite formula in Philadelphia is 
that of Dr. Meigs, known as Meigs' Food : — 

2 parts cream. 

1 part milk. 

2 parts lime-water. 

3 parts sugar- water. 

The sugar- water is prepared by putting 18 table- 
spoonfuls milk-sugar to a pint of water. Another 
formula used contains : — 

Cream, E* ss 4 

Milk, §j. 

Water, gv. 

Milk sugar, E il i 3 A- 

Steam 20 minutes and add lime-water. — (Rotch.) 

Dr. Louis Starr gives a very useful dietary for 
infants which has also met with great success. 
Those formulae which especially concern the ob- 
stetric nurse are as follows : — 

Diet for first week : — 

Cream, 2 teaspoon fuls. 

Whey,* 3 teaspoonfuls. 

Water (hot), 3 teaspoonfuls. 

Milk sugar, j£ teaspoonful. 

* Whey is made by adding 3 teaspoonfuls of wine of pepsine to a 
quart of warm fresh milk, and placing the mixture near the fire for 
2 hours ; the curd is removed by straining through muslin. 



CARE OF THE NEW-BORN INFANT. 121 

For each portion ; to be given every 2 hours, 
from 5 a. m. to n p,m., and in some cases once or 
twice at night, amounting to 12 fluidounces of food 
per day. 

Diet from the second to the sixth week : — 

Milk, 1 tablespoonful. 

Cream, 2 teaspoonfuls. 

Milk sugar, *£ teaspoon ml. 

Water, 2 tablespoon mis. 

For one portion ; to be given every 2 hours, 
from 5 a. m. to 1 1 p. m., amounting to 17 fluidounces 
of food per day. 

The proportion of milk in the mixture and the 
quantity given at one time are carefully increased 
during the succeeding weeks. 

A new-born infant's stomach holds about 1 y 2 ozs. Q uant it y 
The average daily quantity of food required for the feeding and 
first 2-3 months is 20 ounces ; after 3 months, 23 quantity. 
ounces; after 4 months, 27 ounces; 6-12 months, 
30 ounces. The child's appetite, if it be healthy, is, 
however, a good gauge. During the first month, 
\y 2 ounces of the prepared cows' milk may be 
given at each feeding and 12 feedings given daily. 

The temperature of the food should be 99 , ^"Sffood 
Fahr. It is a great mistake to make it too hot. 
The warming of the child's food should be accom- 
plished by setting the filled nursing-bottle into a 



122 OBSTETRICAL NURSING. 

vessel of hot water. It may be heated quickly 
over a gas jet by setting the bottle into a tin mug 
rilled with water and holding it over the flame. 
Suggestions concerning the modification of food, 
when milk thus prepared does not agree with 
foo'oS a infants, will be given in another chapter. When the 
to^ither^s mother's supply of milk is scanty, and the baby 
milk ' cries with hunger, occasional meals of the above 
preparations will be a great aid in its management, 
sterilization In the artificial feeding of infants in the Woman's 
Hospital, sterilized milk alone is used for the vari- 
ous preparations employed. 

By sterilizing milk is meant the process of de- 
stroying any poisonous matter which may have 
found its way into it. Exposure to the atmosphere 
and admixture with particles of dust and dirt during 
its transportation, with want of care as to cleanli- 
ness of vessels, etc., in which the milk is kept, 
induce certain fermentative changes, which cause 
it to sour and to produce digestive disturbances. 
Sterilization destroys the germs of poisonous matter 
by subjecting the milk to a high degree of heat 
Apparatus under pressure. Many forms of apparatus have 

for steriliza- . 

tion. been devised for this purpose. The one in use at 

the Woman's Hospital is called Blair's Sterilizing 
Apparatus. It is very similar in general construc- 
tion to the one devised by Dr. Louis Starr and 
shown in the cut. This consists of an oblong case 



CARE OF THE NEW-BORN INFANT. 



123 



of tin fitted with a tight cover. Into this a movable 
wire basket, holding ten bottles, is placed. The 
bottles are of flint glass, graduated and fitted with 
rubber corks having a glass plug fitted into an 



Fig. 18. 




Sterilizer (Dr. Louis Starr).* 



opening in their centres. The rules for using the ^lizing 
sterilizing apparatus are as follows : — milk * 

1st. Cleanse the bottles thoroughly. 

2d. Fill each with the milk you wish to use, put 



* " Hygiene of the Nursery," Philadelphia, I 



124 OBSTETRICAL NURSING. 

in the rubber cork without the glass plug (this 
leaves a small opening in the rubber cork) ; set the 
bottle in the basket, then in the boiler; fill the 
boiler with water almost as high as the milk in the 
bottle ; boil about ten minutes, or, better, as Dr. 
Starr expresses it, " until the expansion that pre- 
cedes boiling has taken place in the milk ;" then 
put the glass plugs tightly in each stopper and boil 
for fifteen to twenty minutes more. Should the 
rubber corks incline to come out during the second 
boiling, put them in firmly. 

3d. Keep in a cool place till needed for use. 

4th. When to be used, place a bottle of the milk 
thus prepared in the tin mug which accompanies 
the apparatus. Pour hot water in the mug until it 
is as high as the milk in the bottle. Heat the milk 
to the temperature desired for feeding (99 Fahr.) ; 
remove the rubber cork and put on rubber nipple, 
and feed. 

5th. Cleanse each bottle immediately after the 
milk in it is used. Do not keep milk in a bottle 
that has had some used out of it. 

6th. If the steaming process is preferred, place 
the basket, without the bottles, in the boiler, fill with 
water up to but not above the bottom of the basket, 
place the bottles in the basket and proceed as 
before. 

Milk should be sterilized as soon as possible after 



CARE OF THE NEW-BORN INFANT. 1 25 

it has been served each morning. Each bottle, when 
emptied, should be thoroughly washed. If the 
whole contents of the bottle are riot used after it is 
opened, the remainder must not be used for the 
child nor allowed to remain in the bottle. 

Milk sterilized in this way will keep for days^ n e gthof 
without spoiling, as it is hermetically sealed and ^^ ^ 
has been deprived of all unhealthy germs. Dr. keep - 
Louis Starr makes the assertion that it will keep 
for eighteen days if the heating is continued for 
thirty minutes. 

Sterilized milk is useful when traveling, as it may Conveni- 

• 1 • 1 t 1 i 1 • rr- 1 r ence wnen 

be carried without any trouble, the difficulty of traveling. 
obtaining fresh milk being thus overcome. Its use 
makes the management of babies during the heat 
of summer much easier. 

A word remains to be said concerning feeding- j^Jfe"! nd 
bottles and rubber nipples. n^ppfJs. 

The bottle should be of clear glass, with a 
rounded bottom, of a shape convenient to clean, 
so that no particles may cling about corners which 
cannot be reached, serving as a source of trouble 
afterward. The graduated bottle is very nice, as it 
enables the quantity of each of the materials used 
in the preparation of the feeding to be mixed 
directly in the bottle, instead of being first measured 
out in a graduate. 

Feeding-bottles with India-rubber tubes are very 



126 



OBSTETRICAL NURSING. 



objectionable, for the tubes are difficult to keep 
clean, and a drop or two of milk left behind will 
often be sufficient to turn the next supply sour, 



Fig. 19. 




Graduated Nursing Bottle (Dr. Louis Starr).* 

causing the infant much sickness and suffering. 
Nurses are prone, also, with these tubes, to place 



* " Hygiene of the Nursery," Philadelphia, 1889. 



CARE OF THE NEW-BORN INFANT. 1 27 

the baby in its crib with the bottle of milk by its 
side and the nipple in its mouth. The heat of the 
child's body tends to sour the milk, the liquid may 
run low, and the child suck in considerable air. 
The neck of the bottle should always be kept filled 
with the liquid while the child is nursing, hence 
the position of the bottle must be changed. A feed- 
ing-bottle fitted with a rubber nipple requires to be 
held in the nurse's hand during the feeding, and is, 
on that account, to be preferred. There should 
always be two nursing-bottles for each baby, one 
being kept under water or filled with a soda solu- 
tion while the other is in use. Immediately after 

J Cleaning of 

the meal the bottle should be cleaned, etc. Scald- pursing 

y bottle. 

ing water should be used, and then the bottle 
filled or placed beneath a solution of bicarbonate 
of sodium — ordinary baking soda — a teaspoonful 
to the pint, until it is again needed, when the soda 
solution should be emptied out and the bottle thor- 
oughly rinsed with cold water. Some use salicyl- 
ate of sodium for the cleansing solution in prefer- 
ence to the bicarbonate. 

Two nipples should be in use at the same time, Rubber 

- nipples. 

being used alternately, and no nipple should be 
used longer than two weeks. A soft rubber nipple of 
conical shape is the best, because it can be more 
readily cleaned. The black rubber is generally 
softer than the white and is to be preferred. The 



128 OBSTETRICAL NURSING. 

opening at the top of the nipple should not be too 
large, as that would permit the milk to flow through, 
when the suction produced by the child's mouth is 
necessary to the food being taken in a natural man- 
ofTubbe? ner - S° soon as the meal is over, the nipple should 
nipple. be removed from the bottle, brushed with a stiff 
brush, wet with cold water on the outside, then 
turned inside out and similarly brushed on its inner 
surface. It should then be put in cold water and 



Fig. 20. 




Rubber Nipple (Starr). 

allowed to stand until wanted. A nurse's sense of 
smell should be keen enough to enable her to 
detect the slightest sourness about a bottle or 
nipple. 
Time The baby should be fed slowly — taking often ten 

required . . r 

for feeding, to twenty minutes for its meal, bucking from an 
empty bottle should never be permitted. 

Preparation it is a bad plan to make the whole day's supply 
of food in the morning. Each meal should be 
separately prepared, to be really fit for use. 



CARE OF THE NEW-BORN INFANT. 1 29 

The sterilization of the quantity of milk to be 
used during the day may all, however, be accom- 
plished at one time. 

In lieu of the regular sterilizing apparatus, milk improvised 

& m & rsr sterilizing 

may be similarly boiled in a water-bath formed by apparatus. 
any ordinary boiler, the milk. being contained in a 
glass fruit-jar with a screw lid. After coming to 
the boiling-point, or boiling about two minutes 
without the lid, the latter may be screwed on and 
the boiling continued. A better way is to put the 
jar in a colander placed over a steaming tea- 
kettle in place of the lid. The milk should be 
allowed to boil in the open jar for about two 
minutes ; the jar lid then being screwed down, it 
should steam for twenty minutes. 

Beside good food and sufficient warmth, babies Free ., .. 

<=> ' ventilation. 

need an abundant supply of fresh air, hence the 
room should be kept pure and wholesome. 

In fine weather, after the first three or four weeks, The daily 
a baby should be carried out in the open air every 
day for a time. 

It is preferable to carry the child in the arms, 
rather than to place it in a baby coach. It can 
thus be kept warmer, and any evidence of chilling 
will be sooner detected by the appearance of the 
baby's face. 



CHAPTER IX. 
MANAGEMENT OF THE LYING-IN. 

Rest. Immediately after the delivery it is necessary 

that the patient should have rest. The room 
should be kept exceedingly quiet and the shades 
drawn down so as to subdue the light. 

Light sleep. The patient may be allowed to sleep, but the 
nurse, during this time, should watch her very 
carefully, as there is a liability to bleeding when 
the sleep is too deep, owing to the general relaxa- 
tion induced by sleep. She should draw the bed- 
clothes up at one side from time to time, to see 
how much blood is lost. 

Absence of There should be no unpleasant smell about a 
confinement room, plenty of fresh air should be 
allowed to enter, and all discharges should be at 
once removed from the room. 

^"^ion While the patient sleeps, and after the child has 

clothing, received proper attention, the nurse should place 
the soiled sheets, towels and all articles stained 
with blood, in cold water, to soak. 

afterbinh ^e afterbirth, also, should be disposed of. If 
in the country, it should be buried in a hole dug in 
the yard, two or more feet deep. It should never 

130 



MANAGEMENT OF THE LYING-IN. I3I 

be thrown down a water-closet or privy. In the 
city it is best to burn it, at night. It may be put in 
the range or stove and well covered up with coals. 
Clots of blood may safely go down the water- 
closet, as they readily dissolve. 

To return to the soiled clothing left after a con-^ es as of 
finement — though a trained nurse will not often be^g^f 
called upon to attend to the washing of these 
articles, there will be times when it would be better 
that she should do so, both to save the patient 
expense and trouble and to prevent their lying 
about too long. At any rate, she should know 
how it should be done. Should the clothing be 
put to soak before the blood has dried into it, and 
allowed to remain for a few hours, the water being 
changed as often as needed, the washing will not 
be difficult. 

As a rule, it is not best that a nurse should leave 
her patient or the baby long enough to attend to 
this wash, hence it is advisable to have it put out 
or done by some one else in the house. The soak- 
ing ought, however, always to be attended to by 
the nurse, because it facilitates the subsequent 
washing. 

In the after-care of the patient the nurse should 
attend to the washing of the mother's and baby's 
napkins. She should, if needed, wash the baby's 
flannels and slips. 



132 



OBSTETRICAL NURSING. 



Visitors. 



Puerperal 
mania. 



Food of 
lying-in 
patient. 



Dietary of 
the lying-in. 



For a week a newly-confined patient should see 
no visitors. Even the husband should not remain 
in the room long at a time. No painful or exciting 
news should be communicated to the patient, as a 
distressing form of mental trouble to which lying- 
in women are prone may be thus induced. This 
is known as " puerperal mania." 

After the patient rouses from her first sleep she 
is generally hungry. The nurse should have 
learned from the physician before he left what he 
would prefer her having. A cup of warm milk or 
tea — not too hot — may be given directly after the 
confinement when ether has not been taken, and 
this followed in three or four hours by a light meal, 
as toast and tea or gruel. With regard to the diet 
of the lying-in, nurses must be prepared to follow 
the rules of the physicians for whom they work. 
Some physicians allow considerable variety in the 
food from the beginning. 

The following directions concerning the diet are 
given to the nurses of the Woman's Hospital : " It 
should be remembered in the diet of the lying-in 
woman, that the amount of liquids must be limited, 
not only until after the secretion of milk, but 
also until the supply of milk adapts itself to the 
demand, for the first five or six days after the 
confinement. 

As soon as the patient is made comfortable after 



MANAGEMENT OF THE LYING-IN. 1 33 

the birth, she should have a cup of warm milk or 

weak tea or warm water and milk. 

First meal time : Plate of milk toast or bowl of oat- 
meal gruel, or saucer of wheat germ or boiled rice. 

Second meal : Cup of weak tea or warm milk, dry 
toast, or milk toast, or water toast, or soda 
crackers soaked in hot milk. 

Third meal : Saucer of oatmeal mush or wheaten 
grits, with a cup of tea or warm milk, with 
Graham biscuit or dry toast. 

Forenoon, afternoon, bedtime : Lunch, a cup of 
warm milk, with a piece of dried bread or zwie- 
back. 

Second Day. — The same as above. 

Third Day. — The same, with the addition of stewed 
apples or baked apples for supper. 

Fourth Day. — Breakfast: Soft-boiled egg y dried 
bread, stewed fruit and cup of milk or weak tea. 

Dinner : Plain beef or mutton-broth, dried bread, 
and farina or junket. 

Supper : Baked apples or stewed prunes, saucer of 
wheat germ and zwieback. 

Fifth Day. — Breakfast : Cup of w r eak coffee or 
cocoa, mutton-chop, oatmeal mush, dried bread, 
and a sweet orange or ripe apple. 

Dinner : Beef or mutton-broth or oyster-stew, baked 
potato, stewed tomatoes, dried bread, farina, jun- 
ket, or rice. 



134 OBSTETRICAL NURSING. 

Supper : Stewed fruit, Indian-meal mush and zwie- 
back. 
Sixth Day. — Ordinary plain diet, avoiding salads, 
sour fruit, fried or highly-seasoned meats, fancy 
desserts, or sweets of any kind." * 
This holds good of all subsequent meals. The 
above dietary will require to be modified when 
special indications arise. Should the patient's tem- 
perature rise to ioo° Fahr., or above, she should 
be kept on liquid diet, as milk and beef-tea, alter- 
nately every two hours. 

As liquids favor the secretion of milk, liquid food 
should constitute a large proportion of the nourish- 
ment taken by nursing women throughout the 
lying-in, provided there is not a tendency to over- 
secretion. The diet should be plentiful and nutri- 
tious, but selected carefully with reference to its 
digestibility. As the patient must remain inactive 
for some time, it will not do for her to eat the 
starchy vegetables, pastry or warm breads, for all 
these require very active powers of digestion. 

A nurse should thoroughly understand the art of 
cooking, and be able to provide her patient with 
palatable and nutritious dishes, daintily and prettily 
served on a tray, until, with the physician's consent, 
she takes her place at the family table. Even then 

* Dr. Anna E. Broomall. 



MANAGEMENT OF THE LYING-IN. 1 35 



a nursing woman will need to receive some nour- 
ishment, as gruel, beef-tea, milk, etc., between the 
regular meals, for she must not only provide for 
herself but her child. 

The lying-in lasts six weeks. During this time 1 D H rat 3° nof 
the organs of generation are returning so far as 
possible to their former condition. It is important 
that the patient should have rest, and for at least Sent "o bed. 
two weeks of this time should be in bed. 

The process of changes by which the womb 

shrinks to its normal size is known as " involution." " involu- 
tion. 

This process is favored by the patient lying as much 
as possible on her back, so that the womb does not 
incline too much to one side or the other. 

The discharges of the mother continue about two « Lochia." 
weeks, and they are called the " lochia." For .the 
first twenty-four hours they are blood ; the second 
and third day, watery blood ; from the fourth to the 
sixth day they have a greenish-yellow T coloration, 
and from the tenth to the twelfth day they become 
white. This white discharge may continue for a 
long time after the confinement. The character of 
the discharge will indicate the progress of involution, 
hence the physician should see daily the napkins or 
dressings removed from the patient. Soiled nap- 
kins and dressings should never be kept in the 
patient's room, but in some closed vessel, as a clean 
chamber or a slop jar, with a close-fitting lid, in 



I36 OBSTETRICAL NURSING. 

another room. The existence of the least odor 

about tfie discharges should at once be brought to 

changes of the physician's attention. If napkins are used, they 

napkins and A x J 

dressings. w {\\ neec [ to be changed during the first day about 
every two hours, sometimes oftener, the second 
and third day about every three hours, the fourth 
and fifth day every four hours, until, by the tenth day, 
about three changes are sufficient. The antiseptic 
dressings are changed, as a rule, every three hours 
until the discharge ceases. If it be very scant, a 
change once in six hours maybe sufficient. These 
After-care antiseptic dressings should be burned. The napkins 
and should be soaked in cold water until the blood is 

dressings. 

well out of them, and then thoroughly washed and 
boiled. The boiling is sufficient, if properly done, 
to render them aseptic, but, as an additional pre- 
caution, they may be wrung out in a 1-2000 bichlo- 
cieansing r ^e solution before drying. The patient should 
of patient. k e was } iec j Q ff eac h time the napkin is changed with 

a warm antiseptic solution, as 1-4000 of the bichlo- 
ride of mercury. Care should be taken not to 
irritate the parts. Instead of using a soft cloth to 
wash off the parts, the water may be poured in a 
small stream over them, and a soft, dry cloth pressed 
gently over them to remove all moisture. Especial 
care should be taken, where there are stitches, not 
to pull upon them in any way. 
Bathing. One daily washing of the entire body is, as a rule, 



MANAGEMENT OF THE LYING-IN. 1 37 

desirable. The doctor's advice, however, should be 
asked concerning the matter. This wash, when given 
as a sponge-bath, need not exhaust the patient, nor 
cause too much movement of her body. The pa- 
tient should never feel chilly during this bath ; should 
she do so, the bath must at once be stopped. The 
bath should, of course, be given under cover. The 
increased activity of the skin necessitates especial 
cleanliness, and the daily bath is found, when 
properly given, to be very refreshing. Frequent 
changes of bed and body clothing, too, are neces- 
sary — the body clothing, if possible, daily until the 
discharges cease. 

The bladder is frequently paralyzed after confine- t^ 
ment, as a result of the pressure to which it has 
been subjected during the birth. When it is filled 
beyond a certain limit, it may respond to the irrita- 
tion and a little urine be voided, but the bladder 
not be emptied. The nurse can tell by the amount 
passed whether the patient has probably emptied 
the bladder or not. The secretion of urine early in 
the lying-in is very free, hence the quantity passed 
should never be scant. By placing the hand over 
the lower part of the abdomen, the bladder may be 
felt as a soft tumor on one or the other side, above 
the pubic bone, the womb being felt as a harder 
mass pushed to the opposite side. 

The catheter should not be used without the Use of 

catheter. 



I38 OBSTETRICAL NURSING. 

physician's sanction, but a nurse should never for- 
get to ask very particularly about this matter before 
he leaves the house after the delivery. It is generally 
undesirable to allow a patient to go longer than six 
hours without freely emptying the bladder. As 
over-distention of the bladder prevents proper con- 
tractions of the womb, and, as a relaxed womb is a 
frequent cause of after-pains, it is best to have the 
bladder quite frequently emptied during the first 
twenty-four hours. Hence, if the catheter is per- 
mitted to be employed, it may be well to use it 
about three hours after delivery for the first time 
(the physician having used it, if necessary, immedi- 
ately after delivery). Its subsequent use should be 
limited to about once in six hours, unless its more 
frequent use is demanded by the interference with 
the contractions of the womb caused by over-dis- 
tention of the bladder. The patient should be en- 
couraged to make a trial to urinate as soon as 
possible, so that the use of the catheter may be 
Precautions entirely dispensed with. Great care is necessary 
catheter, in the use of the catheter: 1st, to see that the instru- 
ment is thoroughly clean and kept clean; 2d, to 
see that none of the vaginal discharges are carried 
into the bladder during its introduction ; 3d, to do 
no injury to the mother's parts or give her need- 
less pain. 

The instrument, or silver catheter, should be 



MANAGEMENT OF THE LYING-IN. 1 39 

thoroughly boiled if there is any doubt about its 
being aseptic. When withdrawing it the outer 
extremity should be kept lowered, so that all the 
urine remaining may flow out from it, and no sedi- 
ment settle in the closed end to become a source of 
contamination at some future time. It should then 
be thoroughly washed in hot water, which should 
be allowed to flow through it from the inner toward 
the outer extremity, carrying out any sediment from 
the urine, and it may be kept during the intervals 
of its use in an antiseptic solution — a 2 per cent, 
solution of creoline or carbolic acid. To prevent 
the carrying of the vaginal discharges into the 
urethra the parts should be carefully washed off 
with an antiseptic solution, either by irrigation or 
by means of a soft cloth, before the insertion of the 
catheter. 

The index finger of the nurse's right hand (which Method of 

° o \ using 

should each time be thoroughly cleansed in an anti- catheter - 
septic solution) should be slipped into the vagina 
as far as the second joint, and made to follow the 
anterior vaginal wall down in the median line to 
the vaginal entrance, when a little elevation of the 
surface will be felt, immediately above which the 
orifice of the urethra is to be found. If the finger 
be held with its palmar surface upward and rest- 
ing lightly upon this elevation, the finger being held 
horizontally, a catheter slipped along it will enter the 



I4O OBSTETRICAL NURSING. 

small orifice of the urethra. Should the extremity 
of the catheter seem to meet with any obstruction 
after its entrance into the urethra, a slight with- 
drawal and rotation of the instrument will generally 
carry it in. The use of the catheter need not involve 
the slightest exposure of the patient. A cultivated 
touch will enable a nurse to do better than by sight 
in its use. Hence, it may all be done under cover. 
Station in F° r ^ e ^ rst twenty-four to forty-eight hours after 
ffiXma delivery, particularly if the labor has been a difficult 
one, there is considerable swelling of the parts, which 
offers a mechanical hindrance both to voluntary 
urination and the passage of the catheter. Great 
gentleness is therefore required in the necessary 
manipulations. This swelling in an ordinary case 
should disappear at the end of twenty-four to forty- 
eight hours. Should the inability to urinate per- 
sist after this, it is in all probability due to the 
condition of paralysis before referred to. Especial 
medication by the physician, as the use of muscle 
and nerve tonics, fomentations over the lower part 
of the abdomen and external generative organs, 
hot water in a bed-pan, placed beneath the patient's 
hips, may serve to stimulate voluntary urination. 
The attempt to induce this should be made each 
time before 3 resort to the catheter, as the con- 
stant use of the latter will only keep up the diffi- 
culty. 



MANAGEMENT OF THE LYING-IN. 141 " 

As a rule, there is no movement of the bowels Constipa- 
for the first three days, constipation being due to 
paralysis of the bowels caused by the pressure of 
the gravid womb upon the bowels. Regulation of 
the food will do much to correct this habit, as a 
laxative diet composed mainly of brown bread, oat- 
meal gruel, prunes, etc. An occasional enema of 
warm soap-suds may be needed, or from a tea- 
spoonful to a tablespoonful of glycerine may be 
injected into the lower bowel, or a glycerine or 
gluten suppository be given. If these means do 
not suffice, some medication may be needed. The 
laxative chosen by the physician will depend upon laxative. 
the condition of the breasts, as well as its liability 
to affect the milk. 

Should the breasts be over-distended, a saline 
laxative will be preferred. Thus, two teaspoonfuls 
of Rochelle salts in a half-tumblerful of cold water 
may be given, an additional tumblerful of pure 
water being taken after it. Sulphate of magnesia 
or Epsom salts may be used in the same way, or a 
teaspoonful of cream of tartar may be taken night 
and morning in a cup of sweetened water. 

When the secretion of milk is scanty, a vege- 
table laxative % is to be preferred, as rhubarb, aloes, 
or cascara sagrada. 

At times there is such impaction of the contents ^ i J iema of 
of the lower bowel that an oil injection will be 



' 142 OBSTETRICAL NURSING. 

needed. A gill of cotton-seed oil may be intro- 
duced into the lower bowel and retained for three 
or four hours, after which a small soap and water 
injection will lead to a thorough evacuation of the 
bowel. 
£ are ie S f a nd The care °f the n ippl es an d breasts is very 
breasts. important. If this matter has received proper atten- 
tion during the pregnancy, there will be compara- 
tively little trouble during the lying-in. It is 
important to keep the nipples clean. Milk should 
not be allowed to collect about them, hence imme- 
diately after nursing, while they are swollen and 
soft, they should be washed ; a soft piece of linen 
may be used and cold water, after which they may 
be dried with a soft cloth. This should be repeated 
after every nursing. 
Use of If the skin of the nipple be unusually thin, it is 

nipple m x x ' 

shield. best to avoid having the baby pull directly upon the 
nipple until the milk flows freely, hence a nipple 
shield should be used at least for the first two or 
three days, if not longer. 

Application Should the nipple become sore at any time, the 

to sore rr J ' 

nippies. nipple shield should again be resorted to and used 
until the sore is healed. 

Some application, as a 10 per cent, solution of 
tannic acid in tincture of myrrh, balsam of Peru, 
or a weak solution of nitrate of silver, according to 
the order of the physician, may be painted with a 



MANAGEMENT OF THE LYING-IN. 1 43 

camel's-hair brush over the nipple while it is soft 
and swollen, immediately after nursing. 

For any nipple shield to work perfectly it must Qualities of 
fit tightly, hence an entire rubber shield is not so shield - 
good as some others. Some shields are made of 
part metal and part rubber, others part rubber and 
part glass. The cheapest are the ordinary glass 



Fig. 21. 




Nipple Shield. 

shields with rubber nipples. These cost about 
fifteen cents and are quite as good as those that are 
higher priced. 

A shield is not good if it allows the nipple to be 
drawn out too far. In the intervals of nursing the 
rubber nipple should be kept in cold water after 
having been turned inside out and thoroughly 
cleaned with a brush. 



144 OBSTETRICAL NURSING. 

Nipple Nipple protectors are worn only in the intervals 

of nursing, or during pregnancy, for shaping the 
nipple.* These may be made of lead, glass, or wood. 
Leaden protectors keep the nipples soft in the 
intervals of nursing and have a healing effect upon 
the abrasions and cracks of a tender nipple. Unless 
care be taken, however, to cleanse the nipple thor- 
oughly before the baby nurses, there is danger of 
lead-poisoning. Nipple protectors of glass and 
wood, being open at the top, are intended more to 
keep the clothing of the patient off the tender nip- 
ple. The nipple may, in addition, be kept moist in 
the intervals of nursing by' the application over it 
of a piece of absorbent cotton saturated with a 
mixture of one part glycerine to two parts water. 
7nsh£ [ Tof Nipples vary much in shape — thus, they may be 
nippies. cone-shaped, hollow, mushroom-shaped and de- 
pressed. 
Si° a ne ~d ^ e cone - sna P e d nipple is the best, as it can be 

nipple. readily seized by the child's mouth and the pres- 
sure of the baby lips does not constrict the nipple at 
its base, so as to prevent the free escape of milk 
from the mouths of the milk ducts which open at 
Mushroom the top of the nipple. The mushroom-shaped nip- 
nippie. pie has so narrow a base that the free flow of milk 

may be thus prevented. 
Sppfe W The hollow nipple is apt to get sore from two 

* See Fig. 3, page 33. 



MANAGEMENT OF THE LYING-IN. 



145 



causes : first, by| the forcible suction made by the 
child in emptying the breast; second, by the accumu- 
lation of milk in the depressed portion of the apex. 

The depressed nipple differs from the last class ^ ep [* ssed 
in the fact that there is no elevation of the nipple 
above the surface of the breast, but where the nipple 
should be there is a corresponding depression. 



Fig. 22. 





Cone-shaped. 



Hollow. 




Mushroom-shaped. 



Depressed. 



Very little may be done for such a nipple, and all 
efforts to make a nipple by drawing it out must 
generally be abandoned, as they simply irritate the 
tender skin. 

It is best when nipples of this last class exist to Bandaging 

r r of breasts. 

abandon the idea of nursing the child, and prevent 
the accumulation of milk in the breasts by bandag- 
10 



146 



OBSTETRICAL NURSING. 



mg. 



This should also be done where there is a 
previous history of breast abscess — the breast 
affected being thus bandaged to prevent the attempt 
at secretion by the gland. 



Tig. 23. 




Figure-of-eight of One Breast. 



The firmest bandage is the figure-of-eight of the 
breasts, which may be applied to one or both of the 
breasts according to need. If it cannot be used, 
the wide, straight bandage, similar to an abdominal 



MANAGEMENT OF THE LYING-IN. 



147 



bandage, maybe employed, or the straight bandage 
with straps to fasten it over the shoulders, accord- 
ing to the pattern used by Dr. Garrigues, of New 



Fig. 24. 




Figure-of-eight of Both Breasts. 



# York. Were the milk permitted to accumulate in 
the breast, and there be no ready outlet for it, 
" caked breast" would be apt to ensue. 

By " caked breast" is meant a collection of milk 



Caked 
breast." 



148 



OBSTETRICAL NURSING. 



Rubbing 
of breast. 



intone or the other part of the breast, due to block- 
ing up of a milk-duct. The indications for its relief 
are to empty the breast. The milk may be drawn 
out by a baby if there be a proper nipple, or by the 
use of the breast-pump. 

The breast may be gently rubbed with warm oil 
and stroked from the base toward the nipple to aid 
in carrying the milk toward the mouths of the 



Fig. 25. 





Garrigues' Breast Bandages. 



Fomenta- 
tions. 



milk ducts. Camphor liniment is sometimes used 
as an inunction, alone or combined with laudanum, 
but unless it is the intention to help to dry up the 
milk, camphor should be avoided. 

The use of fomentations before rubbing greatly 
helps to soften up the breast. By fomentations is 
meant the application of flannels wrung out in hot 
water, constantly changed as they cool. These 
applications should be continued for fifteen to twenty 



MANAGEMENT OF THE LYING-IN. 



149 



minutes at a time. After their use, if the baby be 
put to the breast or the breast-pump be used, the 
milk will generally flow quite freely. 

Those breast-pumps are the best which depend Breast 

11 L pumps. 

for suction on the power of the mouth. The 

Phoenix breast-pump is the one generally preferred. 

They may be used by the nurse, or a patient may 

use such a pump herself should a nurse not be 

Fig. 26. 




Breast Pump. 



present. Hand pumps are not good, as too much 
force is apt to be used in making suction — the nip- 
ple may thus be torn off. Where a breast-pump 
cannot be had, a simple contrivance may be resorted 
to for emptying the breasts which is often very 
effective. A bottle filled with very hot water may 
be emptied of its contents, and while still hot the 
mouth of the bottle closely applied over the nipple. 



ISO 



OBSTETRICAL NURSING. 



As the bottle cools the nipple is drawn up into the 
neck of the bottle, and the flow of milk induced. 
When the breasts are pendulous, handkerchief 
wit? 6 ° f bandages, properly applied, make a good support. 



Handker- 
chief 



Fig. 27. 




Handkerchief Bandage of Breast. 



Their application is as follows : " The base of the 
handkerchief, folded as a triangle, should be placed 
obliquely across the chest and under one breast, 
with the apex or summit "of the triangle over the 



MANAGEMENT OF THE LYING-IN. 15 I 

corresponding shoulder; one angle is carried over 
the opposite shoulder, the other under the axilla, 
or armpit, of the same side. These ends should be 
tied on the back of the shoulder, and the apex of 
the triangle pinned to them." — (Smith.) 

Should both breasts need support, a similar ban- 
dage may be applied to the other breast. To pre- 
vent the base of one or both of these bandages from 
slipping up, the ordinary handkerchief bandage has 
been modified in the Woman's Hospital by the do™? ca ~ 
addition of a belt, around the waist, of a strip of mus- chief ei 
lin or ordinary roller bandage, to which the base breast. 
of the bandage may be fastened by safety-pins. 

A simple straight bandage, with a compress to straight 

x ° ° -*- bandage of 

lift the outer, pendulous portion of each breast, is breast - 
sometimes used. ^ 

Another bandage, which has the advantage of DoubleY 
not requiring to be removed when the baby nurses, banda s e - 
is the double-Y bandage, used in the Boston Lying- 
in Hospital. The manner of putting it on is thus 
described by Dr. Worcester : " A single T bandage 
is first made by folding a napkin lengthwise so that 
for an average-sized patient it shall be 32 in. long 
by 3 in. wide. At the middle of this, and at right 
angles to it, is pinned, just between its folds, a nap- 
kin of the same size, similarly folded. This T ban- 
dage is next made into a Y bandage, by making a 
diagonal fold in the middle of the cross-piece, and 



152 OBSTETRICAL NURSING. 

fastening the corners of the plait with safety-pins 
on the outside. The bandage is now ready to put 
on. The tail-piece is passed under the woman's 

Fig. 28. 



Worcester's Y Bandage. The upper figure shows the double Y breast bandage 
in position ; the lower left-hand figure shows how the Y bandage is made. 
The third figure shows how the double Y bandage is completed by- 
fastening the arms of the Y to the tail-piece on the patient's opposite side. 

back, snug up to her armpits, so that the fork of the 
Y just clears one nipple when that breast is held 
upward and inward on the chest. The tail-piece 



MANAGEMENT OF THE LYING-IN. 1 53 

on the other side is carried up on the chest directly 
over the breast. The arms of the Y are then 
brought over the chest, one above and the other 
below the breasts, and their ends pinned to the 
tail-piece, so as to hold both breasts in similar posi- 
tion. A compress of soft linen may be placed 
between the bandage and the outside of the breasts 
and also between the breasts, to prevent their chaf- 
ing. To keep the bandage from slipping down 

Fig. 29. 




Obstetrical Breast Support, with Knitted Bosoms. 

straps of muslin may be passed over the shoulders 
and pinned back and front. To keep it from slip- 
ping up, it may be fastened to the abdominal 
bandage." The bandages referred to are very use- 
ful while the patient is in bed, but when she begins 
to sit up and wear ordinary clothing they will be 
found to be cumbersome. Some such breast sup- 
port as is shown in Fig. 29 may then be found very 
useful. It may be obtained at the Dress Reform 



154 



OBSTETRICAL NURSING. 



Gathered 
breasts. 



Septic 
inflamma- 
tion of 
breasts. 



Emporium, in Philadelphia, and at similar agencies 
in other cities. 

There is nothing in the care of a lying-in patient 
for which a nurse receives more blame than in the 
occurrence of gathered breasts. Abscesses will 
sometimes come, however, in spite of all precau- 
tions, even before confinement. Extreme watchful- 
ness and a prompt reporting of any symptoms of 
beginning trouble, as chilliness, hardness of the 
breasts, sore nipples, etc., will do much to avert 
them. It must never be forgotten that sore nipples, 
by offering an open surface upon the mother's body, 
may become avenues of septic infection. Dirty 
hands or dirty garments touching these surfaces, or 
poison 'from the baby's mouth, may thus enter the 
mother's system. One of the most serious forms 
of inflammation of the breast may thus result from 
blood-poisoning. If the breast has once gathered, 
there will be a tendency for it to gather again. 
Should an abscess threaten by beginning inflamma- 
mation of the breast, the treatment will, of course, 
be directed by the physician. What milk is in the 
breast must be drawn out, and some means used to 
prevent further secretion. Belladonna breast plasters 
were at one time much used, the circular breast 
plasters being obtained at any drug store. The 
belladonna ointment spread on patent lint, shaped 
to the breast, is preferred by some physicians. 



MANAGEMENT OF THE LYING-IN. 1 55 

Simple compression of the breast by a firm bandage 
is generally sufficient, without the aid of other 
measures, in the checking of the secretion. 

Should the breast gather, lancing is inevitable, 
and the sooner the better, so that a nurse should 
keep the physician carefully informed as to the con- 
dition of the breast. Flaxseed poultices may need 
to be applied for a time, both before and after lanc- 
ing. These poultices, to do any good, should be ap- 
plied as hot as possible. The nurse can test the heat 
of the poultice by laying her cheek against it. If she 
can bear this application without finding it too hot, 
the patient will also probably be able to bear it. If 
the poultice be made on flannel it will not lose its 
heat as quickly as when made on muslin. The 
poultices will require changing about once in two 
hours, or often enough to keep them warm ; and 
should be kept up until the abscesses point and are 
evacuated. The nurse should encourage the patient 
to have an abscess lanced, and should have pre- 
pared, at the time of the operation, the antiseptic 
solutions preferred for the physician's hands and 
for washing out the abscess cavity, a syringe, if 
possible, a pus-pan having a concave side to fit 
closely under the breast, some charpie (linen 
threads arranged in bundles for packing abscess 
cavities), soft towels and some absorbent cotton to 
be used in place of sponges for cleansing the 



156 OBSTETRICAL NURSING. 

breast. Before the operation, the breast should 
be washed off with an antiseptic solution. Between 
the applications of the different poultices the breast 
should be similarly washed off by the nurse. The 
physician will probably desire to wash out the 
abscess cavity daily so long as the discharge of pus 
continues, in which case the nurse should have every- 
thing in readiness at the time of his expected visit. 
Constant Sometimes milk runs constantly from the 

flow of J 

milk. breasts. Much may be done to prevent this by 
regular nursing. If it persists, the amount of 
liquid in the food should be restricted. Some- 
times the milk runs from the opposite breast while 
the baby is nursing at one. There is no way to 
prevent this. Some mothers collect it as it drops 
in a small bottle or cup and feed it to the baby. 

insufficient If the mother has only sufficient milk for half 
the day, the baby had better be artificially fed by 
day, the breast milk being reserved for the night, 
as giving less trouble when the care of the child 
devolves upon her. 

After-pains. After-pains are the same as labor-pains, being 
caused by contractions of the womb. They are 
called after-pains because they occur after confine- 
ment. A woman, after the birth of her first baby, 
seldom has after-pains. They may occur with vary- 
ing severity in women who have previously borne 
children. If the bladder and the bowels are properly 



MANAGEMENT OF THE LYING-IN. 1 57 

attended to, and the womb kept well contracted, the 
patient is not likely to suffer much from after-pains. 

These pains seldom last over the second day. 
Should they do so, it is probable that the patient 
is threatened with some inflammation*. 

The occurrence of after-pains should, of course, 
be at once reported to the doctor, and such meas- 
ures for relief carried out as he may suggest. 

The womb will be found to be in two entirely 

different conditions with the occurrence of these 

pains. Hence, we divide the pains into two classes, 

the "expulsive" and the "spasmodic." 

With expulsive after-pains the womb, as it is felt "Expul- 
sive" 

through the abdominal walls, will be found to be after - 

pains. 

large and soft, and the patient will often pass clots. 
The bladder will be frequently found to be over-full 
and the womb pushed high up or to one side. The 
indications are to empty the bladder and to secure 
good contractions of the womb. After the bladder is 
emptied the pain may be relieved by the applica- 
tion of a hot poultice over the lower part of the 
abdomen, and simple fluid extract of ergot may be 
given, if desired by the physician (j4 teaspoonful 
every three hours), until the womb is well contracted. 
A nurse should never give any medicine without 
the direction of the physician. Before entire relief T 

r J Intra- 

lterine 
njections. 



is obtained it may be necessary for the physician to f te 



break down and wash out the clots within the womb. 



I58 OBSTETRICAL NURSING. 

The nurse should slip drawers and stockings on 
the patient in preparation for this operation, as she 
may need to lie across the bed with her hips drawn 
to its edge. A bed-pan, syringe, antiseptic solu- 
tions, receptacle for waste water, and rubber pro- 
tective for bed and floor should be prepared. 

after-pafns. When spasmodic after-pains occur, the womb is 
felt in the lower part of the abdomen as a firm, round 
ball of stony hardness. This is caused by a spasm 
of the muscle fibres in the womb. The remedies 
which would help expulsive pains would only aggra- 
vate this condition. Something must be employed 
which will quickly relax the spasm. The most 
efficient agent is chloroform liniment, which may 
be applied on flannel over the lower part of the 
abdomen. The active counter-irritation thus pro- 
duced will give relief. Should the spasm be very 
severe, the physician may apply pure chloroform 
sprinkled on blotting-paper for a few seconds over 
the lower part of the abdomen until it well red- 
dens the skin. Should no chloroform liniment be 
at hand, a warm flaxseed poultice may help to some 
extent, though not so efficient, as a rule. 

The report. A careful report should be kept by the nurse, 
from which the physician can learn all that has 
transpired in the intervals of his visits. 

Sheets of paper ruled and having headings, as in 
the following plan, are used in the Woman's Hospital. 



MANAGEMENT OF THE LYING-IN. 



159 






3 



(A 
M 

< 




•aMixn 




H 

z 

a 

H 
< 
m 

H 
Q 
55 

w 
g 

u 

s 

w 

i 




Q 
O 
O 




•dSHH 




*dWHX 




•asina 




■anoH 




axva 








i6o 



OBSTETRICAL NURSING. 



Special 
symptoms 
to be 
reported. 



Chill. 



Rise of 
tempera- 
ture. 



Pains. 



Puerperal 
fever. 



The occurrence of pain, any complaint of chilli- 
ness or a decided chill, rise of temperature, rapid 
pulse, sleeplessness, headache, want of appetite, etc., 
should be carefully noted and brought to the physi- 
cian's attention. 

For the first week or ten days it is well to take 
the temperature and pulse in the morning, at noon, 
and in the evening ; after which, if the patient is 
doing well, the morning and evening temperature 
and pulse will be sufficient. 

Should the slightest complaint of chilliness be 
made, the nurse should place extra covers around 
the patient, hot water bottles, if necessary, to warm 
her up, and at the same time give her a warm 
drink, as a cup of hot tea or even hot water. 

The temperature should always be taken after a 
complaint of chilliness, and taken quite frequently, 
as every hour or two, when, if it be found to be 
rising, a note should at once be sent to the physi- 
cian, who may want, under the circumstances, to 
see the patient at once or institute some new line 
of treatment. Pain may be temporarily relieved by 
the application of a hot flaxseed poultice. Grave 
inflammatory and septic troubles are ushered in by 
such symptoms as the above, hence no time should 
be lost in notifying the physician of their occurrence. 

The use of blisters, poultices, packs, vaginal injec- 
tions, and medicinal remedies required in the treat- 



MANAGEMENT OF THE LYING-IN. l6l 

ment of the various forms of " puerperal fever " 
must of course be in exact accordance with the 
physician's directions. 

Such troubles are generally septic, that is, arise 
from blood-poisoning ; and one very important duty 
of the nurse will be to see that the patient takes 
sufficient nourishment to combat the poison in the 
blood. 

Stimulants should never be given without a physi- 
cian's advice, but when ordered great care should be 
exercised in their faithful administration. Egg-nog, 
milk-punch, whiskey-punch, wine-whey, milk in the 
various liquid and semi-liquid preparations, beef-tea, 
broths, etc., will be called for. The nurse should 
be ready with devices to tempt her patient to eat, 
and thus give the most important aid to the arrest 
of the disease. The support of the strength, with 
extreme cleanliness and thorough antisepsis, will 
do much to arrest the course of the terrible mala- 
dies due to blood-poisoning. 

The existence of any sores about the vulva or Puerperal 

J ulcers. 

vagina, when discovered by the nurse, should at 
once be reported to the doctor. These are espe- 
cially dangerous when they take on a grayish sur- 
face, as this indicates that they have already become 
infected by poison. If the disease is not arrested 
here, the whole system may be involved. 

A swelling of one or both legs sometimes comes Milk leg. 
II 



l62 OBSTETRICAL NURSING. 

on after delivery. It is ushered in by acute pain 
and lines of redness accompanying the swelling — 
the vessels of the groin, under the knee or in the 
leg will often feel like cords. This is due to an 
inflammation involving the veins. Sometimes blood 
clots form in the veins, which may be dislodged and 
carried to the heart and lungs, when they are the 
source of the gravest danger. Sometimes abscesses 
form in the leg. The great danger of clots being 
carried in the blood current makes absolute quiet 
imperative. The patient should lie flat on her back, 
and the limb be elevated on pillows or on an inclined 
plane, such as the fracture-box used in certain 
fractures of the lower extremity. 

The application of some soothing ointment, as 
iodine and belladonna ointment in equal parts, over 
the cord-like veins, a hot flaxseed poultice being 
kept over the ointment, will help to relieve pain and 
diminish inflammation. The whole limb should be 
kept warm by a wrapping of cotton batting. The 
limb is most comfortable when slightly bent at the 
knee joint. Should the weight of the bed-clothing 
cause pain a cradle may be made of barrel hoops 
for lifting them off the limb. The cradle is also 
very useful in cases of peritonitis when the same 
difficulty exists. 
Bedsores. Lying-in women should not be subject to bed- 
sores, but should some complication occur, as in 



MANAGEMENT OF THE LYING-IN. 1 63 

some form of blood-poisoning, or should some other 
disease attack the patient during this time, necessi- 
tating long lying, special care is necessary to pre- 
vent bedsores. The parts of the body subjected to 
most pressure should be kept thoroughly dry and 
rubbed with alcohol and alum (a saturated solution) 
once or twice daily. A little cosmoline may then 
be rubbed into the skin, or some drying powder, 
as zinc or starch, may be used. When a sore 
occurs it must be dressed, according to the physi- 
cian's order, with zinc ointment or cosmoline. All 
pressure should be kept off it, if possible, by the 
adjustment of pads and pillows or a rubber-ring 
cushion. 

Puerperal mania is a form of mental trouble which Puerperal 

x mania. 

may affect lying-in patients, particularly when they 
are exhausted from any cause, whether it be mental 
worry or physical ill-health. In true mania the 
patient may be violent and very difficult to 
control. In the melancholic type of this trouble 
she is exceedingly depressed, distrusts her best 
friends, and cannot be roused to take an interest in 
her surroundings. 

As soon as it is noticed that the patient's mind is Removal 

of infant. 

not well balanced the baby should be removed from 
the room, only being brought to the mother when 
asked for. The nurse should then keep a close 
watch over it, as one of the chief symptoms of this 



164 OBSTETRICAL NURSING. 

trouble is a strong aversion to the baby and desire 
to destroy it. 
importance It should never be forgotten that an insane pa- 

of watch- ° L 

fulness. tient should not be left alone for a moment. The 
insane are very cunning, and though apparently 
asleep, may be but watching their opportunity to 
indulge in some mad freak, as jumping out of the 
window, dashing down the stairway and out of 
doors, etc. The windows, therefore, should be in 
some way protected. A nail or screw may be 
driven into the window-casing so as to prevent the 
raising of the sash, except so far as ventilation re- 
quires. The door had best be kept locked, the 
nurse keeping the key. 

Treatment. The treatment will mainly consist in keeping up 
the nourishment and in kind, gentle, tactful man- 
agement. The patient should be made to interest 
herself in outside things, by the judicious turn given 
to the conversation by the nurse, by engagement in 
some kind of fancy-work, or in games which will 
help to divert the mind. 

She should not be crossed, neither should she be 
deceived. The nurse should so manage her as to 
inspire a thorough confidence and liking toward her 
on the part of the patient. If she has not these, 
she had best give up the case, as she will not be 
able to help the patient. 

Should the patient absolutely refuse to eat, the 



MANAGEMENT OF THE LYING-IN. 1 65 

physician may direct the nurse to introduce the Forced, or 

r r artificial 

food into the stomach by means of a rubber tube feeding. 
passed through the nostril and down the oesopha- 
gus, or gullet. Care should be taken to do no 
injury in the introduction of this tube, which should 
be well greased with cosmoline and made to follow 
closely the direction of the passages it is made to 
enter. A funnel is then connected with the outer 
extremity, through which the milk or broth, etc., 
may be poured into the stomach. 

Should the patient be exceedingly restless and ^""5 ° f 
disposed to jump out of bed, to her own detriment, patient * 
she may be fastened into the bed by means of a 
sheet, doubled lengthwise, placed over the middle 
portion of the body from the arm-pits to below the 
knees and carried under the bed, to be fastened 
either beneath the bed or to one side of it. The 
feet may be bound together loosely at the ankles 
by a piece of roller bandage and fastened to the 
footboard of the bed. The hands may be bandaged 
together (being placed the one on top of the other) 
by means of a roller bandage, though this is not 
necessary except when they are used to do herself 
injury. Where patients are so violent as to need fe^ce to 
such restriction, however, it is better to have them SSnXrAe 
removed to some institution for the insane as soon in 
as possible, where there is better provision made 
for their management. The use of sedative reme- 



1 66 



OBSTETRICAL NURSING. 



Protection 

from 

poisoning. 



The first 
sitting-up 
after 
delivery. 



Subinvo- 
lution. 



dies by the physician will generally prevent the ne- 
cessity for resorting to such extreme measures for 
confining the patient in ordinary cases. 

Medicines should, of course, never be left in the 
patient's room, even when the nurse is there, unless 
under lock and key. The duration of this malady 
varies from weeks to months, in some cases be- 
coming chronic. Convalescence is generally very 
gradual. Patients may have long periods of lucid 
thought, and seem apparently well, only to unex- 
pectedly return to their vagaries ; so that the nurse 
should never relax her quiet vigilance while in 
charge of the case. 

The old, time-honored belief that a woman 
should sit up on the ninth day is subject to many 
exceptions, which should be understood by the 
nurse as well as by the physician. The true gauge 
is the progress of involution. This may be de- 
termined by the height of the uterus (which ought 
to sink behind the pubic bone before the patient is 
allowed to sit up) and by the character of the dis- 
charges. So long as there is any blood in the dis- 
charge the patient should not sit up, for this is an 
indication that involution, or the shrinking of the 
womb, is not going on properly. This condition is 
known as "sub-involution," and if neglected may 
lead to chronic disease of the womb. The use of 
the recumbent posture, frequent hot injections 



MANAGEMENT OF THE LYING-IN. 1 67 

given by the nurse, or electricity administered by 
the physician, may be necessary to overcome it. 
Let the patient understand the wisdom of her con- 
finement to bed under such circumstances, and she 
will generally yield gracefully to the necessity. 
The first sitting-up should be in bed, the patient's 
back being supported by a bed-rest. Should no 
bed-rest be found in the house, a chair turned 
upside down, with its back toward the patient, over 
which a pillow is placed, offers a very good sub- 
stitute. 

After sitting up in bed for a day or two, from a 
half-hour to an hour if there be no discharge, the 
patient may have her flannel wrapper and stockings 
and bedroom slippers put on, and be allowed to sit 
up in an easy chair. It must be remembered that 
this is the time when the patient w-ill be most sus- 
ceptible to cold, therefore every precaution must be 
taken to prevent her exposure to draughts. Should 
the patient seem to grow tired before the half-hour 
or hour is up, she should be put back in bed. The 
interval for sitting up may be gradually increased 
from day to day, until she is up the greater part of 
the day.. No going up and down stairs should be 
permitted until the physician sanctions it, which is, 
in ordinary cases, about the fifth or sixth week, 
when one such journey a day is generally per- 
mitted. 



i68 



OBSTETRICAL NURSING. 



Observance 
of physi- 
cian's 
orders. 



Order 
board. 



That there may be no misunderstanding between 
physician and nurse, the orders of the physician in 
every case should be immediately set down in 
writing when given, so that by constant reference 
to them the nurse may do her full duty by the pa- 
tient. It is well, for this purpose, to have a piece of 
paper ruled so that at the right side there shall be 
two columns, one headed A. M., the other P. M. 
The stated hours for the administration of medi- 
cine or carrying out of treatment may then be 
placed opposite the special directions for each, and 
a pencil mark be drawn through the figure repre- 
senting the hour when the matter has been at- 
tended to. 

An order board, as used in the Woman's Hos- 
pital, is prepared as follows : — 



Orders for Treatment of Mrs. Richards, Oct. ioth, 1889. 



Full breakfast, dinner and supper, 

A teaspoonful of medicine (light or dark), . 

Sponge bath, 

Lunch of gruel or beef-tea, 

Glass of milk at bedtime, 

To sit up half an hour with bed-rest, . . . 



A. M. 



6 

6.30 

10 

9 



P. M. 



12, 6 
I2.3O, 6.30 



Nurse's Name. 



MANAGEMENT OF THE LYING-IN. 1 69 

A fresh board should be prepared for each day's 
work. In ordinary cases, which run an uneventful 
course, these boards, with the hours crossed off, 
serve the purpose of a report as well. 



CHAPTER X. 

CHARACTERISTICS OF INFANCY IN HEALTH 
AND DISEASE. 

weTghfof A healthy baby, if born at full term, should 
bab y .° rn weigh 3250 grammes, or about 7 fibs. Its length 
kngthf e should be, on an average, 50 cm., or 20 inches. 

The head and trunk of the child are developed 
out of proportion to the limbs, so that the navel is 
tiesof a de" below the middle of the child's body. This greater 
development of the upper part of the body is due 
to the fact that in the womb this portion of the 
child's body receives the greater amount of nour- 
ishment. The subsequent growth consists largely 
in the development of the lower limbs. 
skin. The skin of a newborn baby varies in color from 

a pink to a decided red. The redness is more 
marked in premature babies. From the third to 
the fourth day this redness disappears, and the 
"?^y. ce „ peculiar yellowish tinge, known as "baby jaun- 
dice," appears, as a result of the changes in 
the circulation. This is not true jaundice. This 
yellowish tinge of the skin should disappear by the 
end of the second week. At the same time that 
the skin begins to change color, from the third to 

170 



FEATURES OF INFANCY IN HEALTH AND DISEASE. 171 

the fourth day, it begins to scale or peel off. This 
is most noticeable about the fifth day, and lasts 
about sixteen days. 

The baby's limbs should be plump and well- The form - 
rounded. The abdomen is prominent, as compared 
with the chest. 

The shape of the head varies very much. At Shape of 
times it is perfectly rounded, again it will be elon- head - 
gated and oval-shaped. 

Pressure during labor, either from the walls of Effect of 
the pelvis or as a result of the use of instruments, pressure 
will cause at times considerable temporary distor- 
tion in the shape of the head. To allay swelling 
and prevent discoloration induced by bruising, 
fomentations may be used, either of simple hot 
water or hot water containing a little fluid extract 
of hamamelis. 

When there has been a good deal of pressure on 
the baby's head during the birth, the bones will 
sometimes override each other, and this will be 
shown by elevations or ridges upon the baby's 
head, which soon disappear when the head is no 
longer subjected to pressure. These ridges, which 
are converted into soft grooves on the removal of 
pressure, indicate the separation between the dif- Sutures. 
ferent bones of the head, and are called " sutures." 
The larger soft places are called " fontanelles." The Fontaneiies. 
largest is on top of the head just above the fore- 



Closure of 

anterior 

fontanelle. 



172 OBSTETRICAL NURSING. 

head. It is called the " anterior fontanelle," com- 
monly known as " the opening of the head." It is 
about large enough for the tips of two fingers to 
cover, when of normal size, and is kite-shaped. A 
much smaller three-cornered fontanelle is found at 
the back of the head and two behind the ears. 
These very soon fill up with bone. 

The large anterior opening does not close entirely 
until a child is about eighteen months of age. 
Should it remain open longer, it is a sign of con- 
stitutional weakness. In a healthy baby the sur- 
face of this fontanelle should be on a level with the 
Pulsation of surrounding bones of the skull. A slight pulsation 

fontanelle. ...... . , . . r 1 

may be noticed in it, due to the pulsation of the 
blood vessels in the brain. Should the fontanelle 
Depression b e much depressed at any time, it would indicate a 
fontanelle. i ow s tate of vitality. Care should be taken not to 
Avoidance permit any undue pressure on this part of the baby's 
of pressure. head, as the brain here lies very near the surface. 

The fashion some old monthly nurses have of 
trying to shape the head by the pressure of the 
hands is dangerous, as the brain may be thus 
injured. As the head bones are soft, the child 
should not be allowed to lie too continuously on 
either side or on the back, as this will cause flatten- 
ing of the part pressed upon, 
changes in j? or the first two days of a baby's life it loses 

weight. J J 

weight, but by the third day it begins to gain, and 



FEATURES OF INFANCY IN HEALTH AND DISEASE. 1 73 

by the end of the first week it should weigh what 

it did at birth. The average daily gain is 30 Average 

grammes, about 1 oz. The following facts con- 

. Loss and 

cerning the early changes in weight are obtained s ain - 
from Gregory : — 

An infant born at full term weighs from 6 to 7 
pounds, 7 pounds being an average weight. For 
the first two or three days of life there is a loss of 
4 ounces to 7 ounces, then a regular gain, so that 
by the eighth to the ninth day the initial loss has 
been made good. The following figures express 
the average daily loss and gain during the first six 
days of life : — 



First day, . . . . 


Loss of 139 grammes, 


or nearly 5 ounces. 


Second day, . . 


" 64 


a 


" 2^ ounces 


Third day, . . 


Gain of 33 


a 


about 1 ounce. 


Fourth day, . . 


« 50 


n 


" 1 3^ ounces 


Fifth day, . . 


" 50 


a 


" i^f ounces 


Sixth day . . . . 


" 36 


a 


" i 1 /. ounces 



The child's weight should be doubled in the fifth 
month, and trebled in the twelfth month. The 
baby should be able to hold up its head in the 
sixteenth week, at the same time sitting up. It 
should stand by the thirty-eighth week. It should 
"take notice" and be able to grasp things by the 
third to the fourth month. 

It is important that a nurse should know the 



174 OBSTETRICAL NURSING. 

above facts as to the child's development, to be able 
to report satisfactorily concerning its condition to 
the physician in attendance. 

sieep. A large proportion of the time of early infancy 

is spent in sleep. The more premature the baby, 
the more constantly does it sleep. During sleep 
the eyelids should be tightly closed. A partial 
separation of the lids, showing the whites of the 
eyes, is an indication either of some disease, or of 
pain, from whatever cause. 

d e nf. ira " The respirations of a healthy baby when awake 
may be very irregular, some inspirations being 
shallow and others deep — at times hurried, and 
again slow. The only time when the respirations 
can be satisfactorily counted is when the child is 
asleep, for then the breathing is more regular. The 
rise and fall of the abdomen may then be noted 
(for the breathing of an infant is abdominal). The 
number of respirations in a minute average 44. So 
quiet is the healthy breathing of early 'infancy that 
there is no motion of the nostrils or of the lips, or 
even of the chest, to indicate the incoming and out- 

increasein going of air. Fever, colic and lung trouble will 
greatly increase the number of respirations in a 
minute, making them mount up to 60 or 80, or 
even higher. Nervous excitement has a similar 
effect, though this is temporary. 

In brain trouble, a slowing of the respirations 



respira 
tions. 



FEATURES OF INFANCY IN HEALTH AND DISEASE. 1 75 

occurs, so that they may get down to 8 in a minute, slowing of 
When the act of breathing is painful a moan or cry tions ra 

i r : . ~, Painful 

accompanies each act of respiration. The expan- breathing. 
sion of the nostrils with each inspiration indicates 
a want of sufficient air space in the lungs. In con- 
nection with any lung trouble a bluish coloration "Cyanosis/' 
of the lips and face generally is a bad symptom, as 
it indicates that sufficient air does not enter the 
lungs to purify the blood. 

Little reliance is to be placed upon the pulse of infantile 
a baby as indicative of disease, for it is characteris- pu se 
tic of the infantile pulse that it is very rapid, very 
easily affected by external or internal causes, and 
notably irregular. The average pulse of the new- 
born baby is 140. If a baby is well-nourished, it 
is too fat to enable the pulse in the radial artery 
to be counted. Hence the pulse is more easily 
obtained in the temple, or at the ankle. If not 
thus readily obtained, the heart beats may be 
counted by holding the hand over the baby's heart. 
The temperature of a child of this age is also Tempera- 
subject to rapid changes, the result of slight 
causes. The average temperature is 99 Fahr., 
but a cold or an attack of indigestion may cause 
a sudden increase, with as sudden a return to 
normal when the cause is removed. 

A sub-normal temperature is an indication of sub-normal 

tempera- 
lowered vitality, the result of some drain upon the ture. 



I76 OBSTETRICAL NURSING. 

system, as of an exhaustive diarrhoea, or of some 

constitutional weakness. This fall of temperature 

is a dangerous symptom in infants. The tip of the 

Symptoms nose and the extremities of the child, if cold, also 

of lowered ' 

vitality. indicate a condition of low vitality, and require that 
the child should receive very especial care from the 
nurse as to the supply of food and warmth. In 
fever the back of a child's head feels very hot, as 
The also do the palms of the hands. The cries of a 

a a ciy. age ° child form a special language by which its needs 
may be made known. Every nurse should learn to 
distinguish the peculiarity in the different kinds of 
cries, so as to meet the varying demands thus indi- 
cated. A healthy, well-trained baby rarely cries, 
' Of hunger, unless hungry, when the cry will be constant and 
very persistent until the want is satisfied ; the upper 
part of the body is moved at the same time, espe- 
cially the arms and head. The cry induced by ear- 
Ear-ache. J m J J 

ache is also unappeasable, and generally accom- 
panied by a drawing of the hand up to the head. 
A similar gesture accompanies the cry induced by 
Brain brain trouble, which is a shrill scream, often wak- 

trouble. . . . 

ing the child during sleep. 
Lung A cry accompanying a cough is an indication of 

pain in the chest. The paroxysmal character of 
Colic. colic is indicated by the characteristic cry which 

accompanies it — a sharp, sudden cry — the limbs at 

the same time being drawn up toward the abdomen. 



FEATURES OF INFANCY IN HEALTH AND DISEASE. \JJ 

An evacuation of the bowels may precede or follow 
the cry. 

If, in nursing, a baby seizes the nipple by the Sore mouth, 
mouth and drops it suddenly with a cry, doing this 
repeatedly, there is in all probability some soreness 
of the mouth, which should be discovered and 
treated. However heartrending the cry, the baby Secretion 
does not secrete tears until the third month of in- of tears * 
fancy. Hence the common saying, that a baby 
cannot suffer pain because it sheds no tears while 
crying, is not supported by fact. 

A wrinkling of the forehead vertically, produced Facial 

expression. 

by drawing the eyebrows together, indicates pain 
about the head. A sharpening or play of the nos- 
trils exists in lung troubles. A drawn look about 
the mouth is found with digestive troubles, as flatu- 
lent colic. The stools of a very young baby fed^°^ ents< 
on breast milk should be of a yellow or orange 
color. Three or four evacuations a day are 
natural. They should contain no curds. Stools of 
bottle-fed babies are lighter and more offensive. 
The number of times a new-born baby urinates Urination, 
will vary much with the weather and the conditions 
under which the child is placed. It is not unusual 
in cold weather for the napkin to need changing 
almost every hour. Healthy urine should not 
stain the napkin. 



12 



CHAPTER XL 



THE AILMENTS OF EARLY INFANCY. 



It is not proposed in this chapter to take up all 
S e £fan?y. the ailments of infancy, for the term " infancy" 
comprises a time beginning with the birth of the 
child and lasting until the first dentition. 

The obstetric nurse remains with the patient 
from four to six or eight weeks. During this 
time many deviations from the normal, healthy 
state may be met with in the child, and these 
she should be quick to observe and know how 
to manage. 

One of the most important conditions of this 
period is " prematurity " — a result of the too early 
birth of the child. 

A premature birth is one that occurs at any time 
after the child is " viable," that is, capable of living 
after its birth. The term of viability has been set 
at twenty-eight weeks, or seven lunar months. 
Deliveries occurring previous to this time are called 
"miscarriages." 

It may be that with improved methods of man- 
agement the period of viability may be placed 

i 7 8 



Prematu- 
rity. 



Viability. 



THE AILMENTS OF EARLY INFANCY. 1 79 

at an earlier date, but this is as yet a matter for 
proof.* 

It has generally been conceded that a child born 
at six lunar months cannot live, that at seven 
months it stands little chance, that at eight months 
its chances are better, and at nine still better. 

The popular notion that an eight-month baby 
(counting the calendar months) does not stand so 
good a chance of living as a seven-month baby is 
altogether wrong. Great care is needed for pre- 
mature babies. They especially need regular feed- 
ing and to be kept very warm. The skin, being 
thin and delicate, will also require very careful 
attention. 

Until within a few years the matter of keeping The "cou- 

V6USC 

the baby sufficiently warm was exceedingly diffi- 
cult to manage. The French invention of the 
" couveuse," or " brooder," has simplified the matter 
very much. It was first used in some of the French 
lying-in hospitals in 1881. Since then it has come 
into quite general use in France, being employed 
even in private houses. Many different forms of 
the apparatus now exist. The one most commonly 
used in France is Tarnier's invention. This has 



* The French claim that by means of gavage and the cou ve use, or 
hatching- cradle, the actual period of viability has approached six 
months of intra-uterine life. 



i8o 



OBSTETRICAL NURSING. 



been used for some time with great satisfaction in 
the Woman's Hospital, of Philadelphia. 

It consists of a wooden box, whose interior is 
divided into an upper and lower compartment. 
There is a space about four inches wide at one end 
of the upper compartment which communicates with 

Fig. 30. 




Tarnier's Couveuse. 



the floor below. Here two or three large sponges 
on a wire stem are placed. The lid of the box at 
the opposite end contains a chimney, in which a 
helix rests on a pivot. 

The upper compartment of the box is intended 
for the baby, in the lower one are several stone jars, 
which are to be kept filled with very hot water. At 



THE AILMENTS OF EARLY INFANCY. l8l 

the end of the box furthest away from the open 
space which communicates with the chamber above, 
a register is fixed, which may be opened or closed 
at will. The air enters through the register, is 
heated by passing over the hot stone jars, moistened 
by the wet sponges in the space between the upper 
and lower chambers, and finds its exit from the 
chimney, in which it keeps the little wheel revolving. 
The motion of this wheel indicates whether the 
circulation of air within the couveuse is perfect or 
not. A thermometer fastened to one side of the 
interior of the box assists in the regulation of the 
temperature, which should be kept at from 85 ° to 
95 Fahr., according to the indications in each case. 
A frame containing a pane of glass forms the top of 
the box. Through this the record of the tempera- 
ture and the condition of the child can be watched.* 

The following directions for the use of the cou- Direct ions 
veuse are given by Dr. Auvard, who superintended for use ' 
its introduction into the Maternite at Paris : — 

To keep up an even temperature, one of the stone 
jars should be refilled about every hour, hour and 
a half, or two hours. 

The apparatus being more difficult to heat when 

* Dimensions of couveuse for a single infant : width, 36 centi- 
metres ; length, 65 centimetres ; height, 55 centimetres. For twins 
a larger case is necessary, and a reservoir which holds a correspond- 
ingly greater amount of hot water. 



1 82 OBSTETRICAL NURSING. 

it stands in a draught of air, it should be placed so 
as to avoid this. 

Should the temperature rise too high, the cover 
may be slipped down a little so as to allow of the 
entrance of air from above, or the inferior register 
may be opened so as to admit a larger quantity of 
air. The partial closure of the register so as to 
admit less air would help to raise the temperature 
when it tends to. fall below the desired point, as also 
would the addition of hotter water to the jars. 

The child should be placed in the upper com- 
partment of the couveuse as in its cradle, being 
removed simply for nursing, its bath and toilette. 
When removed from the couveuse, care should be 
taken to have the temperature of the room suf- 
ficiently warm. Auvard sets this temperature at 
61.2 . We should be inclined to require a higher 
temperature, as from yo° to 75 ° Fahr. 

The length of time the child remains in a cou- 
veuse will vary from fifteen days to three weeks, a 
month, or even more. It should not be removed 
permanently until it has acquired sufficient vigor to 
live in the ordinary atmosphere of the apartment. 
To accustom the child to this atmosphere, it should, 
as it grows stronger, be removed for an hour at a 
time from the couveuse during the warmest part of 
the day. 

It is best to continue the use of the apparatus at 



THE AILMENTS OF EARLY INFANCY. 183 

night for some time after the child becomes accus- 
tomed by day to removal from the couveuse, for the 
danger of chilling from changes in the atmosphere 
is greater at night. 

Auvard recommends the use of the couveuse in all 
cases where the vitality of the child is enfeebled 
either by external causes, as cold, or internal causes, 
as prematurity, congenital feebleness, cyanosis, or 
"blue disease," wasting, or other general maladies 
enfeebling to the new-born. 

To overcome the difficulty in the management of 
this couveuse, owing to the necessity for the frequent 
renewal of the hot-water jars, Auvard has devised an 
improvement, which is shown in Figs. 31 and 32. 

A cylindrical reservoir of metal takes the place 
of the hot-water jars in the lower compartment of 
the couveuse. This reservoir is filled by means of 
a metallic funnel fastened to one end of the box 
and communicating with the cylinder through a 
metallic tube. 

The overflow of the cylinder is provided for by 
a curved metallic tube at the lower part of the 
cylinder, beneath the inlet through which the 
reservoir is filled. 

The air enters by a register on one side of the 
couveuse instead of at the end, as in Tarnier's 
apparatus. The other portions of the apparatus 
are the same as Tarnier's. 



1 84 



OBSTETRICAL NURSING. 



The metallic cylinder is capable of holding ten 
litres of liquid (a litre is a little over a quart). To 
start the apparatus, about five litres of boiling 
water should be poured in, after which three litres 
may be poured in every four hours. When ten 

Fig. 31. 




'Auvard's Couveuse (Interior View).* 

litres are contained in the cylinder, the overflow- 
pipe carries off the excess. Auvard suggests 
having two vessels, capable of holding three litres 
each, keeping one under the escape-pipe and the 
other over the fire, reheating the water in the ves- 



* Archives de Tocologie. 



THE AILMENTS OF EARLY INFANCY. 1 85 

sel filled by the escape-pipe and having it in readi- 
ness for the next change. The two vessels may 
be thus used alternately, and but little time con- 
sumed in the heating of the apparatus as compared 
with that required in the use of Tarnier's inven- 
tion. 

Fig. 32. 



Auvard's Couveuse (Exterior View). 

To empty the cylinder, a rubber tube is attached 
to the escape-pipes, by which it is made to act as a 
siphon— a small quantity of water poured into the 
cylinder through the funnel being sufficient to start 
the liquid. 

Before the couveuse was known premature 



1 86 



OBSTETRICAL NURSING. 



Cotton 
swaddling. 



babies were swaddled in cotton, in order to be kept 
sufficiently warm. The directions for doing this 
are as follows : — 

Take a square baby-blanket and place it diago- 
nally on the table or bed. Turn down one corner 
for four inches distance, to come up over the baby's 
head. Spread over this blanket a lap of raw cot- 
ton. Have the baby's napkin and binder on and 
a flannel undervest. Make a cap out of the cotton, 



Fig. 33. 




Swaddled Baby. 



fitting it over the baby's head and bringing it down 
well under the chin. Then roll the baby up in the 
cotton lap. Bring the blanket around this firmly so 
as to hold it, the portion of the blanket on the 
baby's right being brought over and tucked in on 
the left side, the portion on the left being corres- 
pondingly folded over toward the right. The 
corner of the blanket left at the feet is then folded 
up over the front, and the whole held in place by 



THE AILMENTS OF EARLY INFANCY. 1 87 

means of a strip of muslin bandage or ribbon. 
The bandage is first applied beneath the chin, 
crossed under the back, again crossed in front, the 
ends being brought forward to fasten in a bow- 
knot at the feet. 

The great disadvantages of this method may be 
seen in the restriction it gives to the movements 
of the child's limbs and the difficulty of determin- 
ing when the child's napkin needs changing, also 
the frequent exposure of the child during these 
changes to the ordinary atmosphere. 

The skin of a premature baby should be well Protection 

11 «i of skin. 

greased after every bath, or some oil, as cotton or 
sweet oil, may be used, and will serve the double 
purpose of protecting the skin and giving nourish- 
ment by absorption. 

The child should be fed every hour. As it is Food. 
usually too weak to suck, it is safer to feed the 
baby with a spoon or with a dropper, to make sure 
of its obtaining a sufficient amount of food. From 
one to two teaspoonfuls should be given every hour. 
Breast milk is, of course, the best. It may be 
drawn from the mother's breast and fed to the 
child while warm. The nurse should introduce 
her little finger into the child's mouth and allow 
the milk to trickle slowly down the finger so as to 
enter the mouth drop by drop, while the child 
sucks the finger. Should the mother have no milk, 



1 88 OBSTETRICAL NURSING. 

the first week's feeding recommended by Dr. Starr, 
or sterilized peptonized milk diluted two-thirds 
with boiled and filtered water, should be used — if 
no wet-nurse can be had as a substitute. 
Gavage. Should the baby drink badly and throw up a 

large proportion of the liquid given to it, " gavage " 
may have to be resorted to. The physician must 
authorize the nurse to carry this out, for she should 
never undertake it otherwise. The directions for 
practicing gavage, as given by Dr. Louis Starr, are 
as follows :— 

The apparatus used is quite simple, being nothing 
more than a urethral catheter of red rubber (No. 
14-16, French), at the open end of which a small 
glass funnel is adjusted. The infant upon whom 
gavage is to be practiced is placed on the knee, 
with its head slightly raised ; the catheter, being 
wet, is introduced as far as the base of the tongue, 
whence, by the instinctive efforts at swallowing, it 
is carried as far down as the oesophagus (or gullet) 
and into the stomach. 

The liquid food is next poured into the funnel, 
and by its weight soon finds its way into the stom- 
ach. After a few seconds the catheter must be 
removed, and here is the great point in the opera- 
tion ; it must be removed with a rapid motion and 
at once, for if it be withdrawn slowly all the food 
introduced will be vomited. 



THE AILMENTS OF EARLY INFANCY. 1 89 

Mother's milk is the best for gavage, as at any. 
time, but other kinds of food may be used. The 
amount given and the number of meals will vary 
with the age and strength of the child. From a 
teaspoonful to a dessertspoonful at one time is suffi- 
cient for a very young child, given every hour. Too 
much food would produce indigestion. As the child 
grows stronger this mode of feeding may be made 
to alternate with nursing. Diluted sterilized milk 
peptonized may be used for the alternate feedings. 

Colic is a very troublesome affection of infancy. Colic. 
It corresponds to the dyspepsia of grown people, 
and indicates that the food is either improper in 
quality or quantity. A colicky cry is a sudden, 
sharp cry, the baby drawing up its feet and legs at 
the same time. The feet are generally cold, and 
one indication for* treatment is to warm them ; warm 
socks or woolen stockings should be worn, or hot 
bottles applied to them. 

The abdomen should also be kept warm by the Counter- 

; irritation 

application of heated flannels, or a spice poultice and 

11 . warmth. 

wrung out in hot whiskey, or a flaxseed poultice, 
and kept applied until the baby gets relief. 

To make a spice plaster, a teaspoonful each of Spice 
ground allspice, cloves, cinnamon, ginger, and cay- 
enne pepper, with four teaspoonfuls of flaxseed meal, 
may be quilted into a bag of flannel, 4x8 inches, 
which will fit entirely over the baby's abdomen. 



♦ I9O OBSTETRICAL NURSING. 

.When the spicy smell is lost the plaster is no longer 
good for use. 
on , Warm oil rubbed gently in over the abdomen for 

inunction. 

ten to fifteen minutes at a time, will often give relief 
by leading to the expulsion of the wind causing the 
pain. 

Anise seed jf ftie application of heat is not sufficient, 
anise-seed tea should be given. It is made as 
follows : — 

Over a half-teaspoonful of anise-seed pour a half- 
teacupful of boiling water. Allow it to steep a 
few minutes, until the water tastes strongly of the 
anise-seed. A half-teaspoonful of this may be given 
warm, every ten minutes, until the baby has 'had 
four doses. This brings up wind from the stomach, 
and thus gives relief. Simple hot water will help 
in the same way should anise-seed not be on hand. 
Catnip tea may be made and used according to the 
same directions. These teas are preferred to the 
drop-doses of gin so frequently given. 

Frequent Frequent stools do not always indicate diarrhoea. 
For the first six weeks of its life a child averages 
three or four movements every twenty-four hours, 
after which it has about two a day until it is two 
years old. 

A natural passage for an infant would be of a 
mushy consistency and a yellow or orange color. 
It should contain no curds. Bottle-fed babies have 



stools. 



THE AILMENTS OF EARLY INFANCY. I9I 

whiter and more offensive stools than breast-fed 
babies. 

In diarrhoea there is a change in consistence or 
appearance. A liquid stool, or one colored green, 
or white, or like putty would be abnormal. The 
presence of curds also would show an inability to 
digest the food properly. 

If, therefore, these curds exist in the stools, or the ^noHbod. 
matters vomited be curdy, the indication would be 
to use some alkali or a small quantity of some 
thickening substance, as barley-water, gelatine, or 
one of the prepared foods intended to serve the same 
purpose, or the milk may be peptonized. 

Lime-water is the alkali most usually employed. Lime-water. 
Lime-water contains but about half a grain of lime to 
the fluidounce of water, so that at least a third of 
the feeding should be lime-water where it is used to 
correct indigestion. To make lime-water, a piece of 
lime about the size of the fist should be placed in 
an earthen vessel ; about three or four quarts of water 
may be poured over this, strained thoroughly, and 
then allowed to settle. The water should be used 
only from the top of the vessel. It is better to filter 
it before use. The vessel may be kept filled with 
water so long as any of the lime remains in it, when 
it will be necessary to add more lime. 

When lime-water cannot be obtained, a small 
powder of baking soda — three or four grains — may 



192 



OBSTETRICAL NURSING. 



Barley- 
water. 



Gelatine. 



Infants' 
" foods.' 



be added to the nursing-bottle. These rules apply 
when the baby is artificially fed. Should the baby be 
nursing the breast a teaspoonful of lime-water mixed 
with an equal quantity of boiled and filtered water 
may be given it before each time it is put to the 
breast. 

Of the thickening substances used to help in the 
digestion of food, barley-water is one of the best. 
To make barley-water a gill of boiling water should 
be poured over a teaspoonful of washed pearl bar- 
ley, freshly ground in a coffee-mill and boiled for a 
quarter of an hour, then strained. It should be 
mixed with milk in the proportions required, two- 
thirds, a half, or one-third. 

Gelatine is sometimes used instead of barley- 
water. A piece an inch square of plate gelatine is 
put into a half a tumblerful of cold water and allowed 
to stand about three hours. This may then be 
turned into a teacup and set in a pan of hot water 
and boiled. The gelatine thus dissolves, and, when 
allowed to cool, forms a jelly, of which one or two 
teaspoonfuls may be added to a feeding. 

Of the various kinds of "infant's food/' those in 
which the starch has been made into dextrine or 
grape sugar are the best. " Mellin's Food" and 
" Horlick's Food" belong to this class. A tea- 
spoonful of these dissolved in a little hot water — 
about a tablespoonful — may be added to the milk 



THE AILMENTS OF EARLY INFANCY. 1 93 

for the feeding. These starch foods cannot be well 
borne by a child before it is five or six months old, 
as a rule. 

Condensed milk contains a large proportion of Condensed 
sugar, hence tends to make fat. It is not as nour- 
ishing as many other forms of food. Babies fed on 
it, though large, are generally far from strong, and 
are very apt to suffer from indigestion. 

A careful regulation of the diet, as suggested by df"s Broom ~ 
Dr. Anna Broomall, for the early weeks of infancy, ietary * 
with the addition of barley-water, lime-water or 
gelatine as indicated, in place of plain water, has 
been found most satisfactory in the care of infants 
in the Woman's Hospital. 

Constipation is not an infrequent occurrence in Constipa- 

r ^- tion. 

infancy. Its management consists principally in 
the use of mechanical irritants for stimulating the 
bowels; thus a soap suppository, an injection of 
warm oil or water, gentle friction over the bowel, 
especially following the direction of the large bowel 
from right to left, are among the most effective 
methods for overcoming this condition. 

The soap suppository is made by taking a piece 
of Castile soap, about one inch long, and shaping it 
into a cone and making it very smooth, so that it 
will not be larger around than the end of the little 
finger. This should be gently insinuated about 



13 



i 9 4 



OBSTETRICAL NURSING. 



half its length into the bowel and held in the open- 
ing until it excites the bowel to act. 

The bowel injection may be given by means of 
the single-bulb syringe, known as the "eye and 
ear syringe." The bulb holds about two table- 



Fig. 34. 




Single-bulb Syringe (Starr). 

spoonfuls of liquid. This may be warm cotton-seed 
oil, sweet oil, or warm water. The nozzle used 
should be small, smooth and well oiled. It should 
be very carefully introduced into the bowel, being 
directed a little to the left side, and the bulb gently 
squeezed to force the contents into the bowel. It 



THE AILMENTS OF EARLY INFANCY. 1 95 

is best that the liquid should be retained for a little 
time before it is forced out. The keeping up of a 
slight pressure over the entrance to the bowel for a 
short time will aid this. 

Rubbing the abdomen for about ten minutes 
(either with or without oil) in the direction of the 
large bowel — that is, upward on the right side as 
far as the border of the ribs, then across to the left 
side and down this side to the pelvis, is often 
efficient. 

Of medicinal measures, glycerin, gluten or cocoa- 
butter suppositories may be resorted to, or manna 
may be given, a piece the size of a pea in the 
child's milk one, two or three times a day, or a 
spoonful of water sweetened with dark-brown sugar. 
Should the child be on artificial food, oatmeal-water 
may be substituted for barley-water in the prepara- 
tion of the food. 

Babies vomit very easily, because their stomachs Vomiting. 
are placed more vertically in the body than when 
they grow older, and over-feeding will cause them 
to bring up the amount in excess of what the stom- 
ach can hold. This vomiting is, of course, not 
serious. Should the vomited matter be sour and 
curdy, the child seem to suffer from nausea, weak- 
ness or fever, it indicates a condition of indigestion 
which should receive attention. The management 
would largely consist in the regulation of the 



196 



OBSTETRICAL NURSING. 



Thrush. 



quality and the quantity of the food, as has just 
been said. 

Thrush is a disease due to want of care of the 
baby's mouth. If milk be allowed to collect on 
the tongue, it sours, and the presence of this acid 
favors the development of thrush, which is really 
a vegetable parasite. White patches may be seen 
on the soft palate, inside the cheeks, lips and 
tongue. The attempt to rub off these patches 
causes bleeding. Gastric catarrh and diarrhoea 
usually accompany this trouble. Care in cleansing 
the child's mouth, after each nursing, will prevent 
the occurrence of thrush. Its treatment consists 
in the use of an alkaline wash, as borax and water 
(twenty grains to the ounce), or some antiseptic 
wash prescribed by the physician. 
r <Red gum." "Red gum" is an eruption which comes out over 
the baby in the first or second week of its life. 
Sometimes these little points of elevation on the 
skin are white. The eruption is then called "white 
gum." These eruptions are due to changes in the 
skin and irritation from exposure to air, and are not 
serious. They rarely last over a week. 

The occurrence of little blisters on the child's 
body, especially on the palms of the hands and 
soles of the feet, is a matter of more moment and 
should at once be brought to the attention of the 
physician, as also should sores around the finger 



White 
gum." 



Blisters. 



THE AILMENTS OF EARLY INFANCY. 1 97 

nails. These indicate a condition of the blood for 
which the use of remedies prescribed by the phy- 
sician will be necessary. 

Sometimes a whitish, glairy discharge comes from Leucor- 

m ' ** J b rhoea,"the 

the privates of little girl babies. This is simply the whites " 
matter found there at birth. Occasionally a little 
blood may be mixed with it, the result of an abra- 
sion in the vagina, and may last a day or two. The 
nurse need not be afraid to remove this matter; 
in fact, if left, it causes irritation of the skin. 

A healthy baby usually wets its napkin very fre-urine. 
quently. It may be every hour during the day, 
and four or five times at night. Sometimes several 
hours may pass and yet the napkin remain dry. 
Either of these conditions may exist in health, 
being dependent largely upon the weather, the food, 
etc. If urine is not passed for twelve hours, the 
condition should be reported. 

The nurse may try to make the baby urinate by 
using fomentations over the bladder and kidneys 
before reporting the matter to the physician. 

The skin of new-born babies is soft and thin, and Care of 
apt to become sore, especially when two surfaces conations. 
rub. First, a little crack is noticed, next day this 
will have widened until, sometimes, a large surface 
is left bare. To prevent this, proper care of the 
baby from the very beginning is important. Never 
use soap. Use warm water in washing it, either 



I98 OBSTETRICAL NURSING. 

plain warm water or water with sufficient powdered 
borax to make it soft, and wash the part very care- 
fully; wipe or mop carefully with a soft cloth. 
Then, to prevent further rubbing of the parts, par- 
ticularly if the skin be broken, use a piece of patent 
lint or soft Canton flannel, with some salve, as zinc 
ointment, containing 20 grs. of boric acid to the 
ounce, spread over it, and carried into the crease 
between two rubbing surfaces. This should be 
changed at least three times a day, or as often as 
the baby soils the napkin. 
Sore eyes. Baby's sore eyes generally come about from some 
infection of the eyes through the mother's dis- 
charges at the time of the birth, or in lying-in hos- 
pitals one baby infects another. Hence, should care 
be taken to cleanse the eyes immediately after the 
delivery with a saturated solution of boric acid, or 
even clean warm water, they may be prevented, as 
a rule, from getting sore. Should the inflammation 
occur, however, the nurse must remember that the 
affection is contagious, through the matter which 
forms in the eyes. This matter is capable of setting 
up an inflammation elsewhere, as when a towel 
used about the eyes may produce a similar inflam- 
mation about the privates ; a scratch or wound in 
the hands may be affected by it. The discharge 
from affected eyes is greenish-white. The poison it 
contains is not destroyed by drying ; it catches and 



THE AILMENTS OF EARLY INFANCY. 1 99 

clings to the room, as the poison of smallpox. 
Hence, a nurse's hands should be thoroughly 
cleansed after washing the eyes, and the nails 
cleaned with a nail-brush. The cloths used in wash- 
ing the eyes should be burned at once after using. 
The greatest precautions must be taken not to 
carry the poison. The nurse's chief care, apart from 
preventing the spread of the trouble, in such a case, 
would be to keep the eye or eyes free of the dis- 
charge by frequent cleansings with warm water 
gently syringed into the eye from the inner toward 
the outer angle, the lids being held everted by their 
gentle separation by the thumb and finger of one 
hand. This washing may need to be done every 
hour. The baby's hands should be kept down by 
fastening a towel around the child's body, pinning 
it in the back. The baby may be held between the 
nurse's knees and its head inclined over a basin, 
which will receive the water from the washing. 
Another basin should contain the clean water to be 
used. Should only one eye be sore, in placing the 
baby in its crib, or laying it down at any time, the 
nurse should be careful to place it with the sore 
eye down, so that any discharge from it may not 
enter the other eye. Any further irritation, as of a 
strong light, should be prevented by keeping the 
baby in a darkened place. Want of attention in 
these cases may cause a child the loss of its sight. 



200 



OBSTETRICAL NURSING. 



Snuffles. 



Discharge 
from ears. 



Enlarge- 
ment of 
breasts. 



Moulding 
of head. 



Scalp 
tumors. 



A room occupied by a baby with sore eyes must 
afterward be carefully disinfected. 

Snuffles, or a cold in the head, shown by watery 
eyes, sneezing, stopping up of the nose, hence diffi- 
culty in nursing, should be managed by keeping 
the nose cleaned out by means of soft linen twisted 
into a cone, greasing the nose well afterward with 
a little oil by carrying it up the nostrils on a twist 
of cotton, greasing the outside of the nose between 
the eyes, and keeping the baby warm. If the baby 
has no hair, the head may be kept warm by a little 
mull, or in winter thin flannel, cap. 

Running at the ears is generally very serious in 
new-born babies, especially when the discharge is 
matter or blood. Some trouble with the brain may 
be indicated, hence the physician should be told of 
it as soon as it is noticed. Of course, the discharge 
entering the ears at the time of the birth should be 
carefully excluded from this disorder. The breasts 
of new-born babies often swell. Generally this 
occurs about the seventh day or during the second 
week. Occasionally they gather, and must then be 
lanced by the physician. Nothing should be done 
for this swelling, except to see that the clothing is 
loose. It disappears in a few days, as a rule. The 
same may be said of swellings on the head or 
about the face, which are due to pressure during 
the birth. One form of scalp tumor may last sev- 



THE AILMENTS OF EARLY INFANCY. 201 

eral weeks before its entire disappearance. The 
latter is the result of temporary injury to the bone, 
and not simply the ordinary swelling which comes 
from interference with the circulation of the blood 
in the soft tissues of this portion of the scalp. 

A child may be born with some deformity, as ? e s formi ~ 
hare-lip, or cleft-palate, or club-foot, or there may 
be some malformation about the external organs of 
generation or the bowel. Whatever the deformity 
may be, the nurse should avoid letting the mother 
know anything about it until the physician has told 
her of it. The shock produced by the knowledge 
may do the mother much injury; hence the phy- 
sician should bear the responsibility of making the 
announcement. A nurse will need considerable 
tact in managing this, as the mother is apt to ask 
to see her baby very soon after its birth. An ex- 
cuse may be made by stating the necessity for 
washing and dressing the child first, or it may 
be asleep and the nurse hesitate to disturb it. 

Quite frequently the bridle beneath the baby's Tongue-tie. 
tongue is too short, and interferes with the free 
movement of the tongue. This is called " tongue- 
tie." It may prevent the child's nursing, and thus 
interfere with its nutrition. If the baby can extend 
the tip of the tongue beyond its lips, it is not prob- 
able that there will need to be anything done, as 
the baby ought to be able to suck a good nipple 



202 OBSTETRICAL NURSING. 

with ease. If the nurse should introduce the tip 
of her little finger into the baby's mouth and allow 
the child to draw on it for a few minutes, she can 
tell whether the act of sucking can be properly ac- 
'complished. Should it not be able to suck, the 
attention of the physician should be called to the 
matter, as the bridle will have to be nicked — an 
operation following which there may be consider- 
able loss of blood, hence it should not be attempted 
except by a physician. 
Bleeding Bleeding; from the cord or navel string may 

from the & & J 

cord - occur within a few hours after birth. It may be 

that the cord has not been tied sufficiently tight, or 
there may have been a very thick cord, which, in 
shrinking, has loosened the ligature. If, after tying, 
the cord has been looped back upon itself and tied 
in a single double bow-knot, this may be untied by 
the nurse and fastened more tightly, so that the 
bleeding may be controlled, or another ligature 
may be thrown around the cord a little nearer the 
body of the child than the first one. Should this 
not check the hemorrhage, the nurse should hold 
the cord firmly between thumb and finger, making 
compression until the physician, who should be 
sent for, arrives. 

of F c a ord g '' The cord commonly falls off about the fifth day. 
The process of ulceration, by which it falls off, 
leaves an open surface on the child's body which 



THE AILMENTS OF EARLY INFANCY. 2O3 

offers an avenue for septic infection. Great care 
should therefore be taken that the nurse's hands 
and anything else that comes in contact with this 
surface are perfectly clean. Should any moisture 
exist about the stump, the use of the antiseptic 
powder of salicylic acid and starch, before spoken 
of, or some other drying-powder of the kind, is 
indicated. It is necessary, also, to see that the 
dressing used is thoroughly antiseptic. When infec- faction of 
tion does exist, it shows itself in the occurrence of nave ' 
inflammation around the navel, or some other part 
of the body ; the child loses flesh, becomes puny 
and emaciated, and abscesses form in various places. 
In the majority of cases it dies, not having suffi- 
cient vitality to survive the poisoning. 

The physician will, of course, prescribe the treat- 
ment for such a child; the nurse will be required 
to see that these directions are faithfully carried out, 
and especially that the child gets all the nourish- 
ment and stimulation required. 

A peculiar yellowish coloration of the skin is to Jaundice 

of infancy. 

be noticed with babies a few days after the birth. 
This disappears, as a rule, by the end of the second 
week, and is due to changes in the circulation. 

Should the jaundice be very marked and seem to 
persist, warm baths once or twice a day, with gentle 
friction over the liver with soap liniment helps, 



Convul- 
sions. 



204 OBSTETRICAL NURSING. 

with free action of the bowels, to overcome the 
condition. 

When the child is suffering from blood-poisoning, 
the peculiar coloration of the skin is due to this 
cause. 

Convulsions may occur in very young infants at 
varying periods after their birth, according to the 
cause which excites them, as, injury during labor, 
indigestion, brain trouble, or other causes. The 
convulsive seizure is generally preceded by twitch- 
ings of the limbs, a rolling-up of the eyeballs, so 
that a large part of the whites of the eyes is seen, 
the thumbs are drawn into the palms of the hands, 
and the fingers tightly clasped over them, or the 
toes may be turned upward or drawn downward. 
During the convulsion the child grows rigid. 

When the attack comes on the nurse should 
quickly undress the child and place it in a warm 
bath. A tablespoonful of mustard added to the 
water will help to stimulate the skin, and the con- 
vulsion will gradually subside. The child, on its 
removal from the bath, may be wrapped in a heated 
blanket, and allowed to perspire freely. On the 
recurrence of the convulsion, the same measure of 
placing the child in the bath should be resorted to, 
until the physician comes and institutes such other 
treatment as he may think proper. 



THE AILMENTS OF EARLY INFANCY. 205 

Bruises, the result of falls or blows, should be Bruises. 
treated by the repeated application of hot com- 
presses. This will relieve pain and prevent swell- 
ing and the black and blue coloration qf the skin 
which would otherwise result. 

The occurrence of a fall or blow should be care- ? alls and 

blows. 

fully reported by a nurse, as the child should be 
carefully examined for the discovery of any injury, 
the serious consequences of which may be averted 
by prompt treatment. The occurrence of paleness 
or vomiting after any such accident is a serious 
symptom and should receive immediate attention 
by the physician. 

A hot, dry skin may accompany various of the Fever, 
disorders of infancy, notably inflammatory condi- 
tions of the digestive organs and of the lungs. 
The normal temperature of a new-born baby is 
99 Fahr., the pulse 140, the respiration 44. 

Should the child seem to be ailing, its tempera- 
ture should be taken. A clinical thermometer may 
be held the requisite number of minutes in the 
groin or in the folds of the neck. Some slip the 
bulb of the thermometer into the rectum. Should 
the temperature be raised, the pulse rapid and the 
respiration hurried and difficult, some lung trouble Lur \g 

r & troubles. 

probably exists. A catch in the breath, noisy 
breathing, a distention of the nostrils on taking an 
inspiration, would indicate the same thing. The 



206 OBSTETRICAL NURSING. 

frequent rubbing of the chest with some counter- 
irritant liniment, as St. John Long's liniment, the 
use of the cotton-jacket for the protection of the 
chest, and v if the child is very feverish, the use of a 
drop of sweet spirits of nitre in a teaspoonful of 
water once in three hours, will constitute the nurse's 
management of the case until the doctor has seen 
the baby and laid down his plan of treatment. The 

jacket!" cotton-jacket is made by taking a high-necked, long- 
sleeved merino vest a size or two larger than would 
be needed by the baby for ordinary wear, opening 
it down the front, and fastening tapes an inch or 
two from each edge in front, by which the jacket 
may be closed. The inner surface of this vest, 
back and front, should be quilted with sheep's wool 
or cotton-batting, the outer surface with oiled silk 
or oiled muslin. This makes a very warm covering 
for the chest. 

Cyanosis or Cvanosis, or " blue disease," comes from the 

" blue " ' 

disease." imperfect closure of an opening which exists in 
the heart before birth. The baby is called a " blue 
baby," and is very delicate in consequence of this 
imperfection in its circulation. Such babies gener- 
ally die, if not during infancy, some time during early 
childhood. With great care they sometimes live, 
and the opening in the heart gradually closes up. 
The special care required is to keep the child warm 
and to handle it very carefully, so that it may be 



THE AILMENTS OF EARLY INFANCY. 207 

subjected to no jar or nervous fright. The child 
should be kept lying on its right [side or on its 
back, in order that there may be as little interfer- 
ence as possible with the action of the heart, and 
that the tendency of the blood to flow through this 
opening in the upper chambers of the heart — from 
right to left — may be overcome. 

Rickets is a disease of the bones — the result of Rickets - 
poor nutrition. There is not sufficient deposit of 
earthy matter in the bones, hence they remain too 
soft and are subject to all kinds of distortions in 
consequence of this. The child may be bow-legged 
and is stunted in its growth, curvatures of the spine 
may exist, or an unnaturally large head, known as 
hydrocephalus, or "water on the brain." 

The baby having this disease is very weak, can- 
not hold up its head well, perspires very freely, 
especially about the head. The complexion is very 
white. The baby has constant trouble with its 
bowels, having green stools nearly all the time. 
The opening in the front of the head is depressed 
and the child seems to waste. 

As the baby grows older, unless well cared for 
the evidences of disease increase, the joints are 
enlarged, the baby cannot support itself on its 
limbs, its teeth are slow in coming, etc. 

The mother can do much for the health of her 
child while still carrying it, by a careful regard for 



208 



OBSTETRICAL NURSING. 



Vaccina- 
tion rash. 



The 
world's 
debt to 
nurses and 
mothers. 



her own general health. After the baby's birth it 
should be kept well nourished, to overcome any 
tendency to this disease. Salt baths, oil baths, and 
the use of tonics ordered by the physician, as cod- 
liver oil, together with careful attention to the qual- 
ity and quantity of nourishment, will do much to 
prevent the progress of rickets. 

The question often arises as to how soon a baby 
should be vaccinated, particularly if smallpox be 
prevalent. As a matter of experience, it is found 
that the vaccination does not " take " well before 
the third month, though, if a younger baby is to 
be exposed to the poison, it would be well to have 
it vaccinated. Vaccination should be avoided, if 
possible, when the baby's health is run down from 
any cause, also at the time of teething. A peculiar 
and distressing form of rash sometimes occurs, or 
there is a great deal of inflammation following the 
vaccination, leading the parents to imagine that the 
baby has been poisoned by the virus used. 

An insight into the frailty of human life in its 
earliest days proves how much the world owes to 
the faithfulness of mothers and nurses for the exist- 
ence of its great and good men and women, and 
should be a stimulus to scientific research in the 
discovery of improved methods for the management 
of infancy. 



INDEX. 



Abdominal binder, 25, 38 

bandages, 48 
Absence of physician during labor, 

83 

Accidents of pregnancy, 41-46 

of labor, 83-100 
Afterbirth, delivery of, 93, 94 

care of, 80 
After-pains, 156-158 
Ailments of early infancy, 178- 

208 
Albuminuria, 26 
Analysis of human and cows' 

milk, 118 
Anise-seed tea, 190 
Antisepsis during labor, 1 79 
Antiseptic dressings (Garrigues ; ), 

49, 50 
Antiseptic precautions after labor, 

95, 135-137 
Apparatus for sterilization of milk, 

123 
Arrangement of patient's clothing 

during labor, 76 
Articles needed in confinement 
room, 53, 75 
for baby's basket, 58, 74 
Artificial breathing, 86-91 

feeding of infants, 1 18-129 
Average length of new-born baby, 

170 
Average weight of new-born baby, 
170 



Avoidance of pressure of foetal 

head, 172 
Auvard's couveuse, 184, 185 

Bag of waters, 62 

Bandaging of breasts, 145-148 

Barley water, 192 

Bathing after delivery, 136, 137 
during pregnancy, 38 
of new-born infant, 1 01-103 

Bearing-down pains, 63, 77 

Bed-sores, 162 

Bichloride of mercury, 68 

Binder (infant's), 105 

Bladder during lying-in, 137 

Bladder during pregnancy, 24-26 

Bleeding from cord, 202, 203 

Blue disease, 206, 207 

Bowel movements of infancy, 177, 
190, 191 

Breast bandages, 49 

Breast pumps, 149 

Breasts, care of, 142-156 

Breech delivery, 95 

" Brown line" of pregnancy, 19 

Bruises, 205 

Caked breast, 147, 148 

Call for nurse, 65 

Carbolic acid solution, 69 

Care after third stage of labor, 94, 

95 
of afterbirth, 80, 131 



14 



209 



2IO 



INDEX. 



Care of breasts in pregnancy, 32 
of infant at birth, 85 
of napkins, 106 
of newborn infant, 101-129 
of new-born infant's eyes 

and mouth, 107 
of perineum, &$ 
Catheter, use of during lying-in, 

137-140 
Caul, 86 

Cessation of menstruation, 17 
Changes of clothing, 73, 74 

in urinary organs during preg- 
nancy, 24-26 
in weight of infant, 108, 109, 
172, 173 
Characteristics of infancy, 170 
Chemilette, 34 
Chill, 160 

Cleansing of baby's eyes, 80 
of mother after labor, 80 
of nursing-bottle, 127 
of physician's hands, 71 
of rubber nipple, 128 
Closure of fontanelle, 172 
Clothing during pregnancy, 33-^S 
Colic, 176, 189 
Colostrum, 113 
Company, 78, 132 
Condensed milk, 193 
Cone-shaped nipple, 144 
Confinement room, 47 

outfit, 70 
Constant flow of milk, 156 
Constipation, 22, 193-195 
Convulsions, 45, 46, 98 

of infancy, 204 
Cooking for lying-in patients, 134, 

135 

Cotton jacket, 206 
Couveuse, 179-185 
Cramps during labor, 78 
Creoline, 68 
Cross-bed, 99 



Cry in brain trouble, 176 

in colic, 176 

in lung trouble, 176 

of earache, 176 

of hunger, 176 
Cyanosis, 175, 206, 207 

Daily airing of infant, 129 
Deepened color of vulva, 18 
Deformities of new-born, 201 
Delivery of head, 84 

of body, 85 
Demeanor of nurse, 98 
Depressed nipple, 145 
Depression of fontanelle, 172 
Descent of child, 59 
Development of breasts, 18 
Diarrhoea, 23 

Diet during pregnancy, 39 
Dietary of lying-in, 132-134 
Discharge from ears, 200 
Divided skirt, 34 
Double Y bandage of breasts, 151- 

153 

Drawing of teeth during preg- 
nancy, 31 
Dressing of cord, 104 
" Dry labor," 45 

Effect of menstruation on lacta- 
tion, 1 1 7-1 1 8 

of pregnancy on lactation, 118 
Emergencies of labor, 83 
Enlargement of abdomen, 18 
Equipoise waist, 37 
Etherization during labor, 100 
Examination by physician, 70 

of urine, 26 
Excessive acidity of urine, 25 
Excoriation of vulva, 25 
Exercise during pregnancy, 40 
Expulsion of afterbirth, 64 

of child, 64 
Expulsive after-pains, 157 



INDEX. 



211 



Facial expression in infancy, 177 

False pains of labor, 60 

Feeding of infant, ill 

of premature infants, 187, 188 

Fever of infancy, 205 

Figure-of-8 of breast, 146, 147 

First sitting-up after pregnancy. 
166 

Flannel underwear, 38 

Fomentations, 148 

Fontanelles, 171 

Food recipes, 11 9-1 2 1 

Forced feeding in puerperal ma- 
nia, 165 

Fore-milk, 113 

Form of new-born baby, 171 

Fruit diet during pregnancy, 39, 40 

Garrigues' breast bandage, 147, 

148 
Garters, 36 
Gathered breasts, 154 
Gavage, 188 
Gelatin, 192 
Gertrude suit, 56, 57 
Graduated nursing bottle, 125, 126 

Handkerchief bandage of breast, 

150 
Hemorrhage after labor, 95-97 
during pregnancy, 41, 42 
from rupture of varicose veins, 

Hemorrhoids, 28, 60 
Hollow nipple, 144 
Hygienic dressing, 33-3S 

Improvised sterilizing apparatus, 

129 
Incontinence of urine, 24 
Infancy, 178 
Infants' binder, 54 
blanket wrap, 56 



Infants' caps, 56 

clothing, 53-57 

crib, 109 

flannel slip, 55 

foods, 192, 193 

socks, 107 

undervest, 54, 107 
Injuries, 205 
Insufficient milk, 156 
Intrauterine injections, 157 
Involution, 135 
Irritability of bladder, 24 

Jaundice of infancy, 170, 171, 203 

Kidneys during pregnancy, 26 
Knitted wool band 54 

Lactation, 11 3-1 15 
Lactometer, 116, 117 
Lancing of breasts, 155 
Language of a cry, 176 
Lateral position during labor, S^ 
Laxatives during lying-in, 141 
Leglettes, 35 

Length of new-born baby, 1 70 
Leucorrhcea, 27 

of infancy, 197 
Lime-water, 191 
Lochia, 135 
Lung trouble, 205 
Lying-in, duration of, 135 

Management of lying-in, 130-169 

of pregnancy, 22-40 
Mask of pregnancy, 19 
Mastitis in infancy, 200 
Meconium, 106 
Message to physician, 67 
Methods of reckoning termination 

of pregnancy, 20 
Microscopic examination of milk, 

117 



212 



INDEX. 



Milk (cows'), 114, 115 

(human), 114 
Milk-leg, 161, 162 
Miscarriages, 43,44 
Modification of infant's food, 191 
Morning sickness, 19 
Mother's dress during labor, 48 
Moulding of the head of new 

born infant, 200 
Mushroom nipple, 144 

Napkins, after-care of, 135, 136 

changes of, 135, 136 

for infant, 54 

for mother, 49 
Nightingale wrap, 51, 52 
Nipple bath, 32 

protector, 32, 33, 144 

shape of, 144 

shield, 142, 143 
Nipples, 125, 128 

care of during lying-in, 142- 

145 

sore, 142-144 
Nourishment during labor, 77 
Nurse dress, 65 

report, 158, 159 
Nursing, 113 

bottle, 125 

Observation of pains, 67 
Obstetrical breast support, 153 
Occlusion dressing, 49, 50 
Odors in lying-in room, 130 
Oil, enema, 141, 142 
inunctions, 191 
Order board, 168 
Outfit for baby, 54-57 
Overdistention of bladder, 26 



Pain during lying-in, 160 

from distention of abdominal 
walls, 30 



Pain in back during pregnancy, 30 
Painful breathing, 175 
Pains of first stage of labor, 63 
Peptonization of milk, 119 
Perineal pad, 50 
Perineum, care of, 84 
Position during second stage of 
labor, 83 
third stage of labor, 93 
Positive signs of pregnancy, 20 
Powder, 103 
Premature rupture of membranes, 

44,45,62 
Prematurity, 178 
Preparations for labor, 47-58 

for obstetrical operations, 98- 
100 

of antiseptic solutions, 68 

of confinement room, 71 

of double bed, 72 

of patient for labor, 67-70 

of permanent bed, 71 

of single bed, 71 
Pressure on foetal head, 171 
Probable signs of pregnancy, 17 
Process of labor, 61-64 
Prolapses, 98 
Protection of bed during labor, 52 

of floor during labor, 52, J^ 
Puerperal fever, 160, 161 

mania, 132, 163 

ulcers, 161 
Pulsation of fontanelle, 172 
Pulse of infancy, 175 

Quantity of food required for in- 
fants, 121 
Quickening, 20 

Red gum, 196 

Respirations of infancy, 174, 175 
Resuscitation of infant, 86-91 
Rest for lying-in parent, 130 



INDEX. 



213 



Retention of urine, 24 

Rickets, 207, 208 

Rise of temperature during lying- 
in, 160 

Rubber nipples, 123 

Rules for sterilization of milk, 
123-125 

Rupture of uterus, 98 

Salivary glands during pregnancy, 

Scalp tumors, 200, 201 
Schultze's method of resuscitating, 

89,90,91 
Sea- voyaging during pregnancy, 

39 
Second stage of labor, 61 

Secretion of tears in infancy, 177 
Securing of maniacal patients, 165 
Septic infection of navel, 203 

inflammation of breasts, 154, 

155 
Serious symptoms during lying-in, 

160 
Shape of new-born baby's head, 

171 
Signs of approaching labor, 59, 60 

of pregnancy, 17 
Skin of new-born baby, 170, 187, 

197, 198 
Sleep after delivery, 130 

of infancy, 174 
Snuffles of infancy, 200 

Soiled clothing after labor, 1 30, 131 
Sore eyes of infancy, 198, 199 

mouth, 177 

nipples, 142-144 
Spasmodic after-pains, 158 
Spice plaster, 189 
Stages of labor, 61, 83 
Sterilization of milk, 122-125 
Stimulants, 76 
15 



[ Straight bandage of breasts, 154, 

! 155 
Striae, 19 

Subinvolution, 166, 167 

Suspicious signs, 1 7 

Sutures, 171 

Swaddled baby, 186 

Swelling of breasts of infancy, 200 
of extremities, 28, 59 
of vulva after delivery, 140 

Sylvester's method of resuscitation, 
87-88 

Symptoms of lowered vitality, 176 

Syringe, 53 

single bulb, 194 

System, 73 

Tact, 78 

Tarnier's couveuse, 180 

Teeth during pregnancy, 30 

Temperature of infancy, 175, 206 

of infants' food, 121 
Temporary bed, 71, 72 
Testing milk, 116 
I Third stage of labor, 61 
Thrush, 196 
Time required for feeding infants, 

128 
Tongue-tie, 201 
Training of infants, 1 1 1 
Treatment of caked breasts, 148 

of puerperal mania, 164 
True pains of labor, 60 
Twins, 93 
Tying of cord, 92 

Union undergarment, 35 
Urination in infancy, 177, 197 
Use of catheter, 26, 137-140 

Vaccination, 208 
Vaginal injections, 81 
Ventilation, 129 



214 



INDEX. 



Vernix caseosa, 101-102 

Viability, 178, 179 

Visitors during lying-in, 132 

Vomiting during labor, 77 
of infancy, 195 
of pregnancy, 31 



Wash dresses, 66 
Weighing the baby, 108 
Weight of new-born baby, 170 
Wet-nurse, 1 13 
Wharton's jelly, 105 
White gum, 196 



